Landiolol Hydrochloride for Prevention of Atrial Fibrillation After Coronary Artery Bypass Grafting: New Evidence From the PASCAL Trial

Study Questions:

Does landiolol (an ultrashort-acting beta-blocker) prevent atrial fibrillation (AF) after coronary artery bypass grafting (CABG)?

Methods:

One hundred and forty patients (mean age 67 years) undergoing CABG were randomized in a blinded fashion to receive either landiolol, 2 mcg/kg/min (n = 70) or saline (n = 70), for 48 hours after the operation. Continuous electrocardiographic monitoring was performed for 1 week. The primary endpoint was AF lasting >5 minutes during the first postoperative week.

Results:

Postoperative AF occurred in significantly fewer patients in the landiolol group (10%) than in the placebo group (34.3%). The mean postoperative blood pressures were similar in the two groups. The mean heart rate was significantly lower in the landiolol group, but no patient developed excessive bradycardia. The mean creatine kinase-MB, troponin, and C-reactive protein levels were significantly lower in the landiolol group. The cost of hospitalization was significantly lower in the landiolol group ($35,680) than in the placebo group ($39,980).

Conclusions:

The authors concluded that landiolol prevents AF after CABG.

Perspective:

Landiolol is an ultrashort-acting beta1-selective beta-blocker that is available only in Japan. It has a higher beta1/ beta2 selectivity ratio and a weaker negative inotropic effect than other intravenous beta-blockers, and less often causes hypotension. In this study, it appears to have reduced the incidence of post-CABG AF by reducing ischemia-reperfusion injury, inflammation, and sympathetic tone. Drugs available in the United States that have been demonstrated to prevent post-CABG AF include oral beta-blockers, sotalol, and amiodarone.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Interventions and Vascular Medicine

Keywords: Japan, Incidence, Reperfusion Injury, Morpholines, Coronary Artery Bypass, Heart Rate, Hospitalization, United States


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