Use of low-dose β1-blocker for sinus tachycardia in patients with catecholamine support following cardiovascular surgery: a retrospective study

BackgroundSinus tachycardia coupled with high-dose catecholamine is common after cardiopulmonary bypass (CPB). The present study assessed the hemodynamic efficacy and safety of combination therapy using low-dose beta(1)-selective adrenergic blocker (landiolol) and inotropes.MethodsThis was a retrospective, single center, self-comparison study at post-anesthesia care unit within a tertiary care center. The study included adults who underwent cardiac surgery with CPB and received landiolol between April 2007 and November 2011. We assessed hemodynamic data prior to and 1h after initiation of landiolol therapy.ResultsWe evaluated 11 patients who were administered 2.61.3 mu g/kg/min (meanSD) landiolol with sinus tachycardia and received catecholamine therapy after on-pump cardiovascular surgery. Landiolol administration led to a significant reduction in heart rate (HR; 112.4 +/- 5.8 vs 126.0 +/- 7.6 beats/min, p<0.001), and a significant increase in stroke volume index (SVI) assessed by pulmonary artery catheterization (22.4 +/- 5.4 vs. 18.9 +/- 4.2mL/m(2), p=0.04). Only one patient showed no HR reduction, whereas seven patients showed decreased HR and increased SVI (64, 95% confidence interval: 30-98%). Moreover, all five patients who received high-dose catecholamine support showed improved hemodynamics. In terms of safety, no patients required cessation of landiolol therapy.Conclusions Low-dose landiolol therapy may safely decrease HR and improve hemodynamics among patients with sinus tachycardia receiving catecholamine treatment after cardiovascular surgery.Trial registration This study is retrospective. Registration number: 11. Duration of registration: April 2007November 2011.