Addition of a β1-Blocker to Milrinone Treatment Improves Cardiac Function in Patients with Acute Heart Failure and Rapid Atrial Fibrillation.

Background: Tachycardia worsens cardiac performance in acute decompensated heart failure (ADHF). We investigated whether heart rate (HR) optimization by landiolol, an ultra-short-acting beta 1-selective blocker, in combination with milrinone improved cardiac function in patients with ADHF and rapid atrial fibrillation (AF). Methods and Results: We enrolled9 ADHF patients (New York Heart Association classification IV; HR, 138 +/- 18 bpm; left ventricular [LV] ejection fraction, 28 +/- 8%; cardiac index [CI], 2.1 +/- 0.3 L/min(-1)/m(-2); pulmonary capillary wedge pressure [PCWP], 24 +/- 3 mm Hg), whose HRs could not be reduced using standard treatments, including diuretics, vasodilators, and milrinone. Landiolol (1.5-6.0 mu g/kg(-1)/min(-1), intravenous) was added to milrinone treatment to study its effect on hemodynamics. The addition of landiolol (1.5 mu g/kg(-1)/min(-1)) significantly reduced HR by 11% without changing systolic blood pressure (BP) and resulted in a significant decrease in PCWP and a significant increase in stroke volume index (SVI), suggesting that HR reduction restores incomplete LV relaxation. Administration of more than 3.0 mu g/kg(-1)/min(-1) of landiolol decreased BP, CI, and SVI. Conclusion: The addition of landiolol at doses of <3.0 mu g/kg/min to milrinone improved cardiac function in decompensated chronic heart failure with rapid atrial fibrillation by selectively reducing HR.