Therapeutic Research

Abstract

Background: We often encounter difficulties in the treatment of atrial fibrillation （AF） with rapid ventricular response（RVR） in patients with acute decompensated heart failure. Calcium antagonists, such as intravenous verapamil and diltiazem, are used to control ventricular response during AF; whereas these have negative effects on heart failure. Landiolol, a short–acting intravenous beta–blocker, is widely used for AF with RVR, although, it is not effective in some cases with the heart rate ≧100 bpm. Here, we investigated the efficacy of bisoprolol transdermal patches in addition to landiolol in AF patients with RVR. Methods: This study conducted on patients with congestive heart failure with reduced cardiac function （left ventricular ejection fraction, LVEF; ≦45％）, AF with RVR, and mild hypertension who were admitted to our hospital. Of these, 5 patients whose heart rate was ≧100 bpm after landiolol administration at the acute phase were additionally prescribed bisoprolol patches. Results: The mean age was 71.4±9.8 years and LVEF was 24.2±14.0％. Bisoprolol patches 3.6±0.9 mg in addition to landiolol 5.8±1.1μg/kg/min were initially administered; the dosage of bisoprolol patches was increased to 5.6±2.2 mg in 2.2±1.5 days. The heart rate was significantly decreased（ 121±11 to 76±16 bpm, p ＝ 0.02）; however, no significant changes in systolic or diastolic blood pressure were found. There was a tendency of lower BNP, but it was not significant （p ＝ 0.06）. A significant improvement in LVEF was observed at hospital discharge（ 24±14％ to 45±17％, p＝ 0.02）. Conclusions: The additional use of bisoprolol patches provided a favorable effect in AF patients with RVR at the acute phase; it would probably contribute to the early termination of intravenous landiolol administration.