Rate control in atrial fibrillation using Landiolol is safe in critically ill Covid-19 patients

Abstract

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/publi cdoma in/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Dear editor, Atrial fibrillation (AF) is frequent in shock patients admitted to the intensive care unit (ICU) [1, 2] and is associated with increased mortality [1]. Several mechanisms are involved in the development of AF in the context of acute circulatory failure, including hypovolemia and β1-adrenergic stimulation in response to endogenous catecholamine production as well as norepinephrine infusion [3]. Atrial fibrillation impairs left ventricular filling and consecutively stroke volume, and in fine potentially aggravates circulatory failure. Pharmacological options to control AF-related tachycardia are limited. Calcium channel blockers are not frequently used because of long-term negative inotropic effects. Amiodarone is the most used drug but its optimal dosage to fine tune heart rate remains an issue, as well as its potential lung toxicity, especially in case of acute respiratory disease. Landiolol is a beta-blocker with highly β1 selective activity, used either in AF patients either to control heart rate or to prevent supraventricular arrhythmia occurrence in the context of cardiac surgery. Landiolol has an ultrashort half-life of 4 min and weaker negative inotropic effect compared with other intravenous β-blockers [4]. A recent randomized controlled trial in patient with sepsis/septic shock developing tachyarrhythmia showed that Landiolol infusion efficiently reduced heart rate without any significant hemodynamic side effect [5]. Here, we described in critically ill patients admitted to the ICU for SARS-CoV-2 infections presenting with AF, our experience of Landiolol use in terms of efficacy and safety.