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

Abstract

Landiolol infusion was started at 0.2 µg/kg/min and dosage reached 3.9 [1.6–7.0] µg/kg/min at 24 h. Overall heart rate reduction was 23% (115 [108–117] vs 150 [138–160] bpm; p < 0.01, Wilcoxon signed-rank test), without any negative impact on global hemodynamic or tissue perfusion parameters (Table 1). SEE PDF] Discussion In this observational uncontrolled study, Landiolol was safely used to lower heart rate in critically ill patients with AF with normal or moderately altered cardiac function. Given that most patients under mechanical ventilation for SARS-CoV-2 infections received norepinephrine and that some of them had moderate left ventricular systolic function, Landiolol infusion was started at very low doses and maximal infusion rate at 24 h was lower than reported in studies on non-critically ill patients [6]. Using this protocol, hemodynamic tolerance was excellent without any significant arterial hypotension or alteration in peripheral tissue perfusion. [...]we observed a decrease in norepinephrine need after Landiolol initiation.