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Effect of Landiolol on Nonsustained Ventricular Tachycardia During Electroconvulsive Therapy

Kim, Chol, MD, PhD; Sakamoto, Atsuhiro, MD, PhD; Ogawa, Ryo, MD, PhD

doi: 10.1213/01.ANE.0000173762.12938.37
Letters to the Editor: Letters & Announcements
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Department of Anesthesiology; Nippon Medical School; Tokyo, Japan; ckim@nms.ac.jp

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To the Editor:

Landiolol, an ultra-short-acting β-adrenergic blocker, could treat tachyarrhythmias safely (1), such as tachycardiac atrial fibrillation in sepsis (2). In other cases, landiolol showed a dramatic effect on nonsustained ventricular tachycardia. For electroconvulsive therapy, 80 mg of propofol and 80 mg of succinylcholine IV were given to a 58-yr-old man with no cardiovascular diseases. Three stimuli of electroconvulsive therapy were delivered at a time until expected efficacy was achieved. The third stimulus triggered off nonsustained ventricular tachycardia that persisted over 2 min. Bolus of 5 mg of landiolol was administered twice and it converted nonsustained ventricular tachycardia to sinus rhythm promptly while it did not affect the hemodynamics. Systolic blood pressure was 110 mm Hg before electroconvulsive therapy and 110–120 mm Hg after the landiolol treatment. Corresponding heart rates were 54 bpm and 80 bpm. As to management of cardiovascular risks of electroconvulsive therapy, a standard text mentions anticholinergic pretreatment can avoid vagal effects such as asystole (3). In this case, 0.5 mg of atropine was administered IV before electroconvulsive therapy. Although atropine might compensate for depressive effect of β-adrenergic blockade on the hemodynamics, this case demonstrated that landiolol was useful for treating nonsustained ventricular tachycardia triggered by electroconvulsive therapy.

Chol Kim MD, PhD

Atsuhiro Sakamoto MD, PhD

Ryo Ogawa MD, PhD

Department of Anesthesiology

Nippon Medical School

Tokyo, Japan

ckim@nms.ac.jp

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References

1. Atarashi H, Kuruma A, Yashima M, et al. Pharmacokinetics of landiolol hydrochloride, a new ultra-short-acting beta-blocker, in patients with cardiac arrhythmias. Clin Pharmacol Ther 2000;68:143–50.
2. Yoshida Y, Hongo T, Sakamoto A, Ogawa R. Successful management of tachycardiac atrial fibrillation in a septic patient with landiolol. Anesth Analg 2005;100:294.
3. Stensrud PE. Anesthesia at remote locations. In: Miller RD, ed. Miller’s anesthesia. 6th ed. Philadelphia: Elsevier Churchill Livingstone, 2005:2654–6.
© 2005 International Anesthesia Research Society