Low dose of landiolol does not prevent postoperative atrial fibrillation after cardiac surgery in non-Asian patients: a multicentre randomised study.

Abstract

Postoperative atrial fibrillation (POAF) affects 30% of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Beta-blockers are the first-line agents recommended for POAF prevention. Landiolol, an ultra-short-acting, highly selective beta-1-blocker, has been shown to be effective in reducing POAF in Asian patients at a low dose of 2 μg kg^-1 min^-1. The aim of this study was to evaluate the effect of a low dose of landiolol for the prevention of POAF in non-Asian patients after cardiac surgery. This multicentre, double-blind, randomised, placebo-controlled superiority trial was conducted from January 2021 to July 2023 at three hospitals in France. Participants were non-Asians ≥65 yr undergoing elective cardiac surgery with CPB and a left ventricular ejection fraction ≥40%. Treatment was started in the ICU and continued for up to 24 h, after which oral beta-blockers were administered. The primary endpoint was the incidence of POAF while in the ICU, analysed by intention to treat. Secondary outcomes included in-hospital and 30-day POAF, ICU and hospital length of stay, and safety outcomes. A total of 318 participants (mean age: 71 [range: 68-76] yr; 21.4% female) were randomised. POAF in ICU occurred in 51/160 (31.9%) participants who received placebo, compared with 47/158 (29.8%) who received a low-dose landiolol infusion (relative risk: 0.93 [95% confidence interval, 0.67-1.30]; P=0.77). No differences were observed in secondary endpoints, including in-hospital POAF and safety outcomes. In non-Asian patients undergoing cardiac surgery with CPB, a low-dose 24-h infusion of landiolol, used as a bridge to oral beta-blockers, did not reduce the incidence of postoperative atrial fibrillation. ClinicalTrials.gov (NCT04607122).