Hemodynamic Changes Following Landiolol Initiation in Patients With Critical Illness Who Developed Tachycardia During Dobutamine Infusion: A Retrospective Observational Study.

Background and objective Dobutamine, a β1-adrenergic agonist, is frequently used to enhance myocardial contractility in patients with critical illness. However, it also increases tachyarrhythmia and myocardial oxygen consumption. Landiolol, an ultra-short-acting and highly β1-selective β-blocker, is used to manage tachycardia in patients with critical illness; however, the combination of a β-agonist and β-blocker seems contradictory at first glance. Previous studies have examined this combination in healthy subjects; however, its effects on patients with critical illness have not been fully elucidated. Hence, this study aimed to address that gap in the literature. Methods This single-center, retrospective, observational study included adult ICU patients who received combination therapy with dobutamine and landiolol between January 1, 2014, and December 31, 2023. Patients who received combination therapy for less than 24 hours or who required extracorporeal circulatory support were excluded. Continuous hemodynamic data were extracted from electronic medical records. Primary outcomes were changes in heart rate (HR) and mean arterial pressure (MAP) after initiation of landiolol administration. Secondary outcomes were achievement of HR <110 bpm, incidence of hypotension (MAP <65 mmHg), change in lactate levels, and rhythm conversion in patients with atrial fibrillation (AF). Linear mixed-effects models were used to evaluate changes in HR and MAP after the initiation of landiolol treatment. Results A total of 72 patients were included in the final analysis. Landiolol treatment was significantly associated with a significant decrease in HR (β = -2.61, p < 0.001) without a significant decrease in MAP. Landiolol treatment also significantly decreased lactate levels (p = 0.029). In patients with atrial fibrillation (n = 53), 79.2 % converted to sinus rhythm or paced rhythm after the initiation of landiolol treatment. Conclusions Landiolol effectively reduced HR without reducing MAP in critically ill patients with dobutamine-induced tachycardia. Furthermore, landiolol may promote rhythm control and improve metabolic parameters such as lactate levels.