A recent prospective, randomized, open-label study published in the Cardiac Failure Review has shown that landiolol, a novel ultra-short-acting β1-adrenoceptor antagonist, may be more effective and safer than esmolol in controlling cardiovascular stress responses during tracheal extubation in patients with left ventricular dysfunction following major vascular surgery.
Conducted at a single center, the study included 39 postoperative intensive care unit (ICU) patients with impaired cardiac function (mean left ventricular ejection fraction [EF] 36.6%) and New York Heart Association (NYHA) class II/III heart failure. Patients were randomly assigned to receive either landiolol (n=19) or esmolol (n=20) during the respiratory weaning process. Doses were titrated as needed, and key cardiovascular parameters including heart rate and blood pressure were monitored every minute for 30 minutes post-extubation.
Landiolol infusion resulted in a significantly more rapid and greater reduction in heart rate compared to esmolol (−40 ± 20 BPM vs −30 ± 16 BPM), without causing hemodynamic instability. In contrast, the esmolol group experienced a significant drop in mean arterial pressure (MAP).