Safety and Efficacy of a Bolus Injection of Landiolol Hydrochloride as a Premedication for Multidetector-Row Computed Tomography Coronary Angiography

Background: We evaluated the safety and efficacy of a bolus injection of landiolol hydrochloride, an ultrashort-acting beta 1-selective antagonist, as an additional treatment after premedication with an oral p-blocker to reduce heart rate prior to multidetector-row computed tomography (MDCT) coronary angiography (CAG). Methods and Results: A total of 458 patients who underwent MDCT CAG were retrospectively enrolled. Image quality and hemodynamic parameters were compared in patients before and after approval of landiolol hydrochloride. If heart rate reduction was insufficient after premedication with an oral beta-blocker, a bolus injection of landiolol hydrochloride (n=66) or other drugs (n=30) was used. The percentage of evaluable images per segment in patients after approval of landiolol (99.3%) was greater than that in patients before approval of landiolol (97.4%, P<0.01). Heart rates before scanning in patients receiving landiolol hydrochloride were similar to those receiving other drugs. Heart rate was significantly reduced approximately 5 min after injection of landiolol hydrochloride and increased shortly. No decrease in systolic blood pressure or other adverse effects was observed. Conclusions: Bolus injection of landiolol hydrochloride sufficiently reduced heart rate without significantly reducing systolic blood pressure and produced a high percentage of evaluable images, suggesting that bolus injection of landiolol hydrochloride as an additional pretreatment is feasible in MDCT CAG. (Circ J 2013; 77:146-152)