LANDI-UP: Strengthening Confidence in Landiolol for Real-World ICU and Critical Care

The LANDI-UP study provides the first European real-world evidence of landiolol use in critically ill patients with supraventricular arrhythmias. This landmark multicentre observational study demonstrates that landiolol achieves effective heart rate control with minimal haemodynamic impact, confirming its safety and efficacy across diverse European ICU populations and validating decades of Japanese clinical experience.

A Landmark European Study

The first European observational study of landiolol—LANDI-UP—marks a milestone in understanding this ultra-short-acting, highly cardio-selective β₁-blocker in critical care. While Japan has accumulated over two decades of real-world experience, comparable European data were previously lacking. LANDI-UP fills this gap, providing the first multicentre, multinational real-world evidence of landiolol's use, efficacy, and safety in European patients with supraventricular arrhythmias (SVA).

Study Overview and Objectives

LANDI-UP was a multicentre, observational, post-authorisation study conducted across 17 centres in eight European countries. A total of 450 patients were enrolled (449 analysed; median age 72 years). Most were treated for atrial fibrillation (73%), frequently with comorbidities such as sepsis, heart failure, or acute myocardial infarction. The study aimed to evaluate the effectiveness and safety of landiolol treatment and to characterise its utilisation patterns in real-world clinical practice.

Results at a Glance

Heart rate (HR) control, defined as HR ≤110 bpm or >20% reduction, was achieved in 74% of patients within 4 hours of infusion discontinuation. HR reduction was consistent across arrhythmia types and comorbidity subgroups, demonstrating robust efficacy in routine clinical conditions. The sinus rhythm conversion rate was 37% at 4 hours.

Landiolol showed good tolerability, with a low incidence of hypotension (2%) and bradycardia (0.2%). No adverse or major cardiac events were attributed to treatment. In total, 17.6% of patients experienced adverse events, mostly mild and unrelated to therapy.

Median infusion duration was 8.9 hours (IQR 2.3–34.0); median starting dose 5.3 µg/kg/min (IQR 2.5–10.0); median maximum dose 10.0 µg/kg/min (IQR 6.0–30.0). Landiolol was administered via central line in 53% and peripheral vein in 45% of cases.

Bridging the Gap Between Clinical Trials and Real-World ICU Practice

LANDI-UP extends the existing Japanese real-world evidence to a European population, demonstrating comparable efficacy and safety. It bridges the gap between controlled clinical trials and daily ICU practice, confirming that landiolol performs consistently across diverse ethnic and healthcare settings.

Despite variations in hospital protocols, comorbidities, and concomitant therapies, dosing closely followed product recommendations, and results were remarkably consistent across subgroups. The findings reaffirm landiolol is a well-tolerated, flexible, and reliable option for acute HR control in critical care.

Why It Matters for ICU Teams

Landiolol offers ICU physicians a fast-acting, titratable agent with minimal haemodynamic impact for heart rate control even in unstable or septic patients. The LANDI-UP findings confirm that clinicians can achieve effective HR reduction while minimising the risk of hypotension or bradycardia, even in multimorbid cases. These results support the use of landiolol for short-term ventricular rate control in complex critical-care settings and align with ESC guideline recommendations for AF and peri-operative tachyarrhythmias.

Conclusion

The LANDI-UP study provides the first real-world evidence in European ICU and critical-care patients, confirming that landiolol is effective, well tolerated, with a favourable haemodynamic profile. Administered in accordance with product recommendations, it achieved consistent HR control with minimal impact on blood pressure and no new safety concerns.

These findings mirror prior Japanese experience, confirming cross-population efficacy and safety. LANDI-UP reinforces the practical advantages of landiolol's pharmacological profile (rapid onset, predictable titration, and swift offset) making it a cornerstone for short-term HR control in critically ill patients and a valuable asset in modern ICU management.

Disclaimer

Point-of-view articles are the sole opinion of the author(s) and are part of the ICU Management & Practice Corporate Engagement or Educational Community Programme.

References:

Dizdarevic A-M, Šramko M, Mangner N, et al. A multicentre observational study on landiolol use, efficacy, and safety in European patients with supraventricular arrhythmia (Landi-UP). Eur Heart J Acute Cardiovasc Care. 2025. doi:10.1093/ehjacc/zuaf129.