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Retrospective study of proarrhythmic effects of levosimendan during the therapy of heart failure


Levosimendan is a new, effective inodilator agent, which is a new alternate drug beside conventional inotropic drugs in treatment of acute and chronic heart failure. Positive inotropic effects of levosimendan is based on myocardial Ca-sensitising. Few clinical data are available about the occurrence of proarrhythmic effects of levosimendan, particularly administered in parallel with catecholamines.


From 1 January 2006 until 30 July, 41 levosimendan-treated patients' data were processed in our retrospective study. Indication of levosimendan therapy was acute heart failure due to myocardial infarction in 23 cases and acute progression of chronic heart failure (NYHA III-IV) in 18 cases. After a 10-minute bolus levosimendan infusion was administered at rate of 0.1 μg/kg/min for 6 hours and 24 hours in each group, respectively. We investigated the occurrence of sustained ventricular or supraventricular arrhythmias for the first 48 hours from the beginning of infusion.


The ratio of hypertension, diabetes, earlier myocardial infarction and ACBG were 58%, 27%, 32% and 15%, respectively, in the monitored population (13 females, 28 males; mean age: 68 years). Three ventricular arrhythmias and one supraventricular arrhythmia were observed during the 48-hour period, all of them occurred in acute heart failure patients with acute myocardial infarction. Parallel usage of catecholamines (noradrenalin and/or dopamine) and levosimendan therapy was observed in three cases, in one of them ventricular tachycardia was observed 3 hours after starting levosimendan infusion. No arrhythmia was observed in chronic heart failure patients. The incidence of proarrhythmic effects during levosimendan therapy was 9.75% of the whole analysed population and was 17.4% at acute heart failure during acute myocardial infarction.


With these results the authors would like to draw attention to the proarrhythmic effects of levosimendan during acute heart failure therapy, especially in the case of parallel usage with catecholamines.

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Zima, E., Szucs, G., Soltesz, A. et al. Retrospective study of proarrhythmic effects of levosimendan during the therapy of heart failure. Crit Care 11 (Suppl 2), P225 (2007).

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