Ultraschnell wirksame Betablocker Esmolol und Landiolol: Aktuelle Rolle in der Intensiv- und Notfallmedizin

Zusammenfassung

Die schnell und kurzwirksamen Betablocker Esmolol und Landiolol sind zugelassen zur Therapie der supraventrikulären Tachykardien. Beide Substanzen sind kardioselektiv mit einer sehr hohen β₁-Rezeptor-Selektivität.

Esmolol und Landiolol können aufgrund ihrer pharmakologischen Eigenschaften eine Alternative zu anderen Substanzen in der Notfall- und Intensivmedizin sein. Die meisten klinischen Studien deuten auf einen günstigen Effekt der ultrakurz wirksamen Betablocker auf die Herzfrequenz und andere hämodynamische Parameter hin. Jedoch fehlen bisher die qualitativ hochwertigen Studien, die eine eindeutige Überlegenheit der beiden β-Adrenorezeptor-Antagonisten gegenüber den etablierten Wirkstoffen zeigen. Angesichts der aktuellen Datenlage bleibt der Einsatz der beiden Betablocker ausgewählten Patienten mit Tachyarrhythmien vorbehalten, die unzureichend auf die bisherige Therapie ansprechen.

Abstract

Supraventricular tachyarrhythmias, especially atrial fibrillation, are common in cardiac and non-cardiac patients with or without surgery. Prolonged rhythm disturbances may impair cardiac function and worsen the clinical outcome and prognosis. Therefore, heart rate control may be necessary to prevent cardiovascular events.

Esmolol and landiolol as ultrashort and rapid acting highly selective β ₁ -adrenergic blockers are of particular interest in the prevention and management of cardiac arrhythmias. This review gives an update on both betablockers and their role in the management of arrhythmias in emergency medicine and perioperative setting.

Schlüsselwörter

Esmolol - Landiolol - Betablocker - Herzrhythmusstörungen

Key words

esmolol - landiolol - betablocker - cardiac arrhythmia

• Literatur

• 1 Metoprolol in acute myocardial infarction (MIAMI). A randomised placebo-controlled international trial. The MIAMI Trial Research Group. Eur Heart J 1985; 6: 199-226
• 2 Intravenous esmolol for the treatment of supraventricular tachyarrhythmia: results of a multicenter, baseline-controlled safety and efficacy study in 160 patients. The Esmolol Research Group. Am Heart J 1986; 112: 498-505
• 3 Abraham WT, Shamshirsaz AA, McFann K. et al. Aquaretic effect of lixivaptan, an oral, non-peptide, selective V2 receptor vasopressin antagonist, in New York Heart Association functional class II and III chronic heart failure patients. J Am Coll Cardiol 2006; 47: 1615-1621
• 4 Abrams J, Allen J, Allin D. et al. Efficacy and safety of esmolol vs propranolol in the treatment of supraventricular tachyarrhythmias: a multicenter double-blind clinical trial. Am Heart J 1985; 110: 913-922
• 5 Adachi T, Sato A, Baba M. et al. Novel use of the ultra-short-acting intravenous beta1-selective blocker landiolol for supraventricular tachyarrhythmias in patients with congestive heart failure. Heart and vessels 2014; 29: 464-469
• 6 Balcetyte-Harris N, Tamis JE, Homel P. et al. Randomized study of early intravenous esmolol versus oral beta-blockers in preventing post-CABG atrial fibrillation in high risk patients identified by signal-averaged ECG: results of a pilot study. Annals of noninvasive electrocardiology: the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc 2002; 7: 86-91
• 7 Barbier GH, Shettigar UR, Appunn DO. Clinical rationale for the use of an ultra-short acting beta-blocker: esmolol. Int J Clin Pharmacol Ther 1995; 33: 212-218
• 8 Er F, Dahlem KM, Nia AM. et al. Randomized Control of Sympathetic Drive With Continuous Intravenous Esmolol in Patients With Acute ST-Segment Elevation Myocardial Infarction: The BEtA-Blocker Therapy in Acute Myocardial Infarction (BEAT-AMI) Trial. JACC Cardiovasc Interv 2016; 9: 231-240
• 9 Hassan S, Slim AM, Kamalakannan D. et al. Conversion of atrial fibrillation to sinus rhythm during treatment with intravenous esmolol or diltiazem: a prospective, randomized comparison. J Cardiovasc Pharmacol 2007; 12: 227-231
• 10 Hearse DJ, Yellon DM, Downey JM. Can beta blockers limit myocardial infarct size?. Eur Heart J 1986; 7: 925-930
• 11 Ibanez B, Macaya C, Sanchez-Brunete V. et al. Effect of early metoprolol on infarct size in ST-segment-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: the Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction (METOCARD-CNIC) trial. Circulation 2013; 128: 1495-1503
• 12 Kiuchi S, Aikawa H, Hisatake S. et al. Efficacy of Intravenous Administration of Landiolol in Patients With Acute Heart Failure and Supraventricular Tachyarrhythmia. J Clin Med Res 2017; 9: 426-432
• 13 Klein G, Wirtzfeld A, Alt E. et al. Antiarrhythmic activity of esmolol (ASL-8052)--a novel ultra-short acting beta-adrenoreceptor blocking agent. Int J Clin Pharmacol Ther Toxicol 1984; 22: 112-117
• 14 Kobayashi S, Murakami W, Myoren T. et al. A low-dose beta1-blocker effectively and safely slows the heart rate in patients with acute decompensated heart failure and rapid atrial fibrillation. Cardiology 2014; 127: 105-113
• 15 Liu P, Wu Q, Tang Y. et al. The influence of esmolol on septic shock and sepsis: A meta-analysis of randomized controlled studies. Am J Emerg Med 2018; 36: 470-474
• 16 Mooss AN, Wurdeman RL, Mohiuddin SM. et al. Esmolol versus diltiazem in the treatment of postoperative atrial fibrillation/atrial flutter after open heart surgery. Am Heart J 2000; 140: 176-180
• 17 Morelli A, Ertmer C, Westphal M. et al. Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock: a randomized clinical trial. Jama 2013; 310: 1683-1691
• 18 Nagai R, Kinugawa K, Inoue H. et al. Urgent management of rapid heart rate in patients with atrial fibrillation/flutter and left ventricular dysfunction: comparison of the ultra-short-acting beta1-selective blocker landiolol with digoxin (J-Land Study). Circulation journal: official journal of the Japanese Circulation Society 2013; 77: 908-916
• 19 Nasrollahi-Shirazi S, Sucic S, Yang Q. et al. Comparison of the beta-Adrenergic Receptor Antagonists Landiolol and Esmolol: Receptor Selectivity, Partial Agonism, and Pharmacochaperoning Actions. J Pharmacol Exp Ther 2016; 359: 73-81
• 20 Oesterle A, Weber B, Tung R. et al. Preventing Postoperative Atrial Fibrillation After Noncardiac Surgery: A Meta-analysis. Am J Med 2018; 131: 795-804 e795
• 21 Okajima M, Takamura M, Taniguchi T. Landiolol, an ultra-short-acting beta1-blocker, is useful for managing supraventricular tachyarrhythmias in sepsis. World J Crit Care Med 2015; 4: 251-257
• 22 Park H, Otani H, Noda T. et al. Intracoronary followed by intravenous administration of the short-acting beta-blocker landiolol prevents myocardial injury in the face of elective percutaneous coronary intervention. Int J Cardiol 2013; 167: 1547-1551
• 23 Platia EV, Michelson EL, Porterfield JK. et al. Esmolol versus verapamil in the acute treatment of atrial fibrillation or atrial flutter. Am J Cardiol 1989; 63: 925-929
• 24 Sakamoto A, Kitakaze M, Takamoto S. et al. Landiolol, an ultra-short-acting beta(1)-blocker, more effectively terminates atrial fibrillation than diltiazem after open heart surgery: prospective, multicenter, randomized, open-label study (JL-KNIGHT study). Circulation journal: official journal of the Japanese Circulation Society 2012; 76: 1097-1101
• 25 Sanfilippo F, Santonocito C, Morelli A. et al. Beta-blocker use in severe sepsis and septic shock: a systematic review. Curr Med Res Opin 2015; 31: 1817-1825
• 26 Sezai A, Minami K, Nakai T. et al. Landiolol hydrochloride for prevention of atrial fibrillation after coronary artery bypass grafting: new evidence from the PASCAL trial. J Thorac Cardiovasc Surg 2011; 141: 1478-1487
• 27 Sezai A, Nakai T, Hata M. et al. Feasibility of landiolol and bisoprolol for prevention of atrial fibrillation after coronary artery bypass grafting: a pilot study. J Thorac Cardiovasc Surg 2012; 144: 1241-1248
• 28 Shettigar UR, Toole JG, Appunn DO. Combined use of esmolol and digoxin in the acute treatment of atrial fibrillation or flutter. Am Heart J 1993; 126: 368-374
• 29 Sung RJ, Blanski L, Kirshenbaum J. et al. Clinical experience with esmolol, a short-acting beta-adrenergic blocker in cardiac arrhythmias and myocardial ischemia. J Clin Pharmacol 1986; 26: A15-A26
• 30 Taenaka N, Kikawa S. The effectiveness and safety of landiolol hydrochloride, an ultra-short-acting beta1-blocker, in postoperative patients with supraventricular tachyarrhythmias: a multicenter, randomized, double-blind, placebo-controlled study. Am J Cardiovasc Drugs 2013; 13: 353-364
• 31 Van de Werf F, Janssens L, Brzostek T. et al. Short-term effects of early intravenous treatment with a beta-adrenergic blocking agent or a specific bradycardiac agent in patients with acute myocardial infarction receiving thrombolytic therapy. J Am Coll Cardiol 1993; 22: 407-416
• 32 Wada Y, Aiba T, Tsujita Y. et al. Practical applicability of landiolol, an ultra-short-acting beta1-selective blocker, for rapid atrial and ventricular tachyarrhythmias with left ventricular dysfunction. J Arrhythm 2016; 32: 82-88
• 33 Xiao J, He P, Zou Q. et al. Landiolol in the treatment of the intraoperative supraventricular tachycardia: a multicenter, randomized, double-blind, placebo-controlled study. J Clin Anesth 2015; 27: 120-128
• 34 Yacobi A, Kartzinel R, Lai CM. et al. Esmolol: a pharmacokinetic profile of a new cardioselective beta-blocking agent. J Pharm Sci 1983; 72: 710-711
• 35 Zangrillo A, Turi S, Crescenzi G. et al. Esmolol reduces perioperative ischemia in cardiac surgery: a meta-analysis of randomized controlled studies. J Cardiothorac Vasc Anesth 2009; 23: 625-632