Clinical experience of landiolol for the treatment of intraoperative rapid atrial fibrillation

A 79-year-old woman with three vessel disease and mitral as well as tricuspid regurgitation underwent operation twice. Preoperatively she had atrial fibrillation and heart failure. The first operation was coronary artery bypass grafting (CABG), and the second was mediastinal dissection for mediastinitis one month after the CABG. In both operations she developed rapid atrial fibrillation and ventricular fibrillation, showing her cardiac irritablility. Both operations were performed under cardiopulmonary bypass and support. In the first operation digoxin and verapamil partly reduced heart rate of rapid atrial fibrillation from 140-170 to 110-140 beats x min-1, which made us use another drug, a short acting selective beta 1 blocker landiolol in the second operation. Landiolol successfully reduced the heart rate of rapid atrial fibrillation from 140-160 to 80-90 beats x min-1. This case demonstrates that landiolol can be safely used in a patient with heart failure due to rapid atrial fibrillation resistant to digoxin and verapamil.