• Ryozo Nagai, Koichiro Kinugawa, Hiroshi Inoue, Hirotsugu Atarashi, Yoshihiko Seino, Takeshi Yamashita, Wataru Shimizu, Takeshi Aiba, Masafumi Kitakaze, Atsuhiro Sakamoto, Takanori Ikeda, Yasushi Imai, Takashi Daimon, Katsuhiro Fujino, Tetsuji Nagano, Tatsuaki Okamura, Masatsugu Hori, and J-Land Investigators.
• Jichi Medical University, Shimotsuke, Japan.
• Circ. J. 2013 Jan 1;77(4):908-16.

BackgroundA rapid heart rate (HR) during atrial fibrillation (AF) and atrial flutter (AFL) in left ventricular (LV) dysfunction often impairs cardiac performance. The J-Land study was conducted to compare the efficacy and safety of landiolol, an ultra-short-acting β-blocker, with those of digoxin for swift control of tachycardia in AF/AFL in patients with LV dysfunction.Methods And ResultsThe 200 patients with AF/AFL, HR ≥120beats/min, and LV ejection fraction 25-50% were randomized to receive either landiolol (n=93) or digoxin (n=107). Successful HR control was defined as ≥20% reduction in HR together with HR <110beats/min at 2h after starting intravenous administration of landiolol or digoxin. The dose of landiolol was adjusted in the range of 1-10µg·kg(-1)·min(-1) according to the patient's condition. The mean HR at baseline was 138.2±15.7 and 138.0±15.0beats/min in the landiolol and digoxin groups, respectively. Successful HR control was achieved in 48.0% of patients treated with landiolol and in 13.9% of patients treated with digoxin (P<0.0001). Serious adverse events were reported in 2 and 3 patients in each group, respectively.ConclusionsLandiolol was more effective for controlling rapid HR than digoxin in AF/AFL patients with LV dysfunction, and could be considered as a therapeutic option in this clinical setting.

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