Managing ICU Arrhythmias: Rapid Rate Control Strategies Using Beta1-Selective Agents-Managing ICU Arrhythmias: Rapid Rate Control Strategies Using Beta1-Selective Agents

Video Transcription

Video Summary

The webcast "Managing ICU Arrhythmias: Rapid Rate Control Strategies Using Beta-1 Selective Agents," moderated by Emily Highsmith, featured Dr. Michael Bristow and Dr. Jean-Luc Fallahi discussing management of new-onset atrial fibrillation (AF) in critically ill patients. Dr. Bristow detailed the pharmacology of landiolol, an ultra-short-acting, highly beta-1 selective blocker with rapid onset and a 4-minute half-life, primarily cleared by renal mechanisms, making it ideal for ICU use. Landiolol offers effective heart rate reduction with minimal blood pressure impact compared to esmolol, due to its limited negative inotropic effects.<br /><br />Dr. Fallahi focused on the clinical management of postoperative and ICU AF, emphasizing treatment of reversible factors such as electrolyte imbalances and hemodynamics. International guidelines recommend beta blockers or calcium channel blockers as first-line rate control; amiodarone is reserved for select cases due to toxicity concerns. Landiolol is favored for its safety, efficacy, and ease of titration via continuous infusion, even in cardiac surgery patients and some ICU settings with norepinephrine support, though caution is advised in septic shock or unstable patients. Practical dosing typically ranges from 5 to 20 mcg/kg/min. Both experts highlighted that rapid ventricular rate control improves outcomes and that beta-1 selective blockers like landiolol optimize safety and hemodynamic stability in ICU arrhythmia management.

Keywords

ICU arrhythmias

atrial fibrillation

landiolol

beta-1 selective blockers

rapid rate control

critical care pharmacology

postoperative AF management

hemodynamic stability

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