---
title: "Landiolol-based intensive rate control for AF in decompensated HFrEF: results of the LARISA trial"
id: "pubmed-41761704"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-41761704"
content_type: "clinical_feed_article"
specialty: "Cardiology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/41761704/"
doi: "10.1093/ehjacc/zuag027"
published_at: "2026-08-29T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Landiolol-based intensive rate control for AF in decompensated HFrEF: results of the LARISA trial
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-41761704
- **Specialty:** [Cardiology](https://medichelpline.com/clinical-feed/cardiology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/41761704/)
- **DOI:** [10.1093/ehjacc/zuag027](https://doi.org/10.1093%2Fehjacc%2Fzuag027)
- **Published At:** 2026-08-29T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The LARISA randomized controlled trial evaluated **landiolol**-based intensive rate control (IRC) with adjunctive **digoxin** versus standard rate control in 40 patients with acute heart failure (AHF) caused by **atrial fibrillation (AF)** and reduced left ventricular ejection fraction (LVEF 130/min and LVEF 20% or an absolute HR <115/min measured at 2 hours after randomization. - IRC achieved faster HR control: median time to HR control 1.5 hours vs 4 hours for standard therapy (P = 0.016). - At 2 hours, median HR reduction was 40% in the IRC group versus 23% in the standard therapy group (P = 0.045). - The primary endpoint was met in 80% of patients in the IRC arm versus 20% in the standard arm (P = 0.04). - IRC produced greater early symptomatic benefit, with more rapid relief of **dyspnoea** and improved lung decongestion compared with standard therapy. - Importantly, the landiolol-based IRC did not result in excess **hypotension** or increased adverse events compared with standard care. - By 24 hours, HR and clinical outcomes were similar between groups, indicating the early advantage of the IRC protocol was time-limited. - The trial is registered at ClinicalTrials.gov (NCT04694092). The publication reports conflict of interest: one author received speaker honoraria; others reported no disclosures.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Cardiology Department, Institute for Clinical and Experimental Medicine (IKEM), Videnska 1958/9, Prague 14021, Czech Republic. * 2 2nd Department of Cardiology and Angiology, General University Hospital, Prague, Czech Republic. * PMID: **41761704** * DOI: [ 10.1093/ehjacc/zuag027 ](https://doi.org/10.1093/ehjacc/zuag027) Free article Item in Clipboard Randomized Controlled Trial # Landiolol for rate control in decompensated heart failure due to atrial fibrillation: the LARISA trial Marek Sramko et al. Eur Heart J Acute Cardiovasc Care. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Eur Heart J Acute Cardiovasc Care Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+Heart+J+Acute+Cardiovasc+Care%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+Heart+J+Acute+Cardiovasc+Care%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/41761704/) . 2026 Aug 29;15(8):622-626. doi: 10.1093/ehjacc/zuag027. ### Authors [Marek Sramko](https://pubmed.ncbi.nlm.nih.gov/?term=Sramko+M&cauthor_id=41761704)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41761704/#short-view-affiliation-1 "Cardiology Department, Institute for Clinical and Experimental Medicine \(IKEM\), Videnska 1958/9, Prague 14021, Czech Republic.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/41761704/#short-view-affiliation-2 "2nd Department of Cardiology and Angiology, General University Hospital, Prague, Czech Republic."), [Ales Benak](https://pubmed.ncbi.nlm.nih.gov/?term=Benak+A&cauthor_id=41761704)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41761704/#short-view-affiliation-1 "Cardiology Department, Institute for Clinical and Experimental Medicine \(IKEM\), Videnska 1958/9, Prague 14021, Czech Republic."), [Jakub Toman](https://pubmed.ncbi.nlm.nih.gov/?term=Toman+J&cauthor_id=41761704)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41761704/#short-view-affiliation-1 "Cardiology Department, Institute for Clinical and Experimental Medicine \(IKEM\), Videnska 1958/9, Prague 14021, Czech Republic."), [Martin Kleissner](https://pubmed.ncbi.nlm.nih.gov/?term=Kleissner+M&cauthor_id=41761704)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41761704/#short-view-affiliation-1 "Cardiology Department, Institute for Clinical and Experimental Medicine \(IKEM\), Videnska 1958/9, Prague 14021, Czech Republic."), [Michal Pazdernik](https://pubmed.ncbi.nlm.nih.gov/?term=Pazdernik+M&cauthor_id=41761704)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41761704/#short-view-affiliation-1 "Cardiology Department, Institute for Clinical and Experimental Medicine \(IKEM\), Videnska 1958/9, Prague 14021, Czech Republic."), [Josef Kautzner](https://pubmed.ncbi.nlm.nih.gov/?term=Kautzner+J&cauthor_id=41761704)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/41761704/#short-view-affiliation-1 "Cardiology Department, Institute for Clinical and Experimental Medicine \(IKEM\), Videnska 1958/9, Prague 14021, Czech Republic.") ### Affiliations * 1 Cardiology Department, Institute for Clinical and Experimental Medicine (IKEM), Videnska 1958/9, Prague 14021, Czech Republic. * 2 2nd Department of Cardiology and Angiology, General University Hospital, Prague, Czech Republic. * PMID: **41761704** * DOI: [ 10.1093/ehjacc/zuag027 ](https://doi.org/10.1093/ehjacc/zuag027) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Aims:** Rate control of atrial fibrillation (AF) in acute heart failure (AHF) with reduced left ventricular ejection fraction (LVEF) is challenging. We evaluated the safety and efficacy of intensive rate control (IRC) using landiolol with adjunctive digoxin. **Methods and results:** Forty patients with AHF due to AF [heart rate (HR) > 130/min, LVEF 20% or <115/min at 2 h. Haemodynamics, dyspnoea, and lung congestion were assessed serially. HR control was achieved faster in the IRC vs. standard group (median 1.5 vs. 4 h; P = 0.016). At 2 h, HR decreased by 40% of the IRC group vs. 23% of standard therapy group (P = 0.045), and the primary endpoint was reached in 80% vs. 20% of the patients, respectively (P = 0.04). IRC resulted in greater dyspnoea relief and lung decongestion without excess hypotension or adverse events. At 24 h, outcomes between the groups were similar. **Conclusion:** In AHF with reduced LVEF, protocolized landiolol-based intensive rate control provides faster and safe HR reduction with early symptomatic benefit compared with standard therapy. Pre-registered Clinical Trial Number: ClinicalTrials.org: [NCT04694092](http://clinicaltrials.gov/show/NCT04694092 "See in ClinicalTrials.gov"). **Keywords:** Arrhythmia; Haemodynamics; Heart failure therapy; Rate control. © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Conflict of interest: M.S. received speaker honoraria from AOP Health. Other authors have nothing to disclose. ## Similar articles * [ Differential Effects of Landiolol in Patients with Atrial Fibrillation and Atrial Tachycardia. ](https://pubmed.ncbi.nlm.nih.gov/39596966/) Ayabe K, Komiyama T, Takekawa H, Kang H, Tsumagari Y, Ito M, Ashikaga K, Shibata Y.Ayabe K, et al.Medicina (Kaunas). 2024 Oct 31;60(11):1782. doi: 10.3390/medicina60111782.Medicina (Kaunas). 2024.PMID: 39596966Free PMC article. * [ Low-dose digoxin improves cardiac function in patients with heart failure, preserved ejection fraction and atrial fibrillation - the RATE-AF randomized trial. ](https://pubmed.ncbi.nlm.nih.gov/40891341/) Bunting KV, Champsi A, Gill SK, Saadeh K, Camm AJ, Stanbury M, Haynes S, Townend JN, Steeds RP, Kotecha D; RAte control Therapy Evaluation in Permanent Atrial Fibrillation (RATE‐AF) Trial Group.Bunting KV, et al.Eur J Heart Fail. 2025 Dec;27(12):2869-2878. doi: 10.1002/ejhf.70022. Epub 2025 Sep 2.Eur J Heart Fail. 2025.PMID: 40891341Free PMC article.Clinical Trial. * [ Effect of Digoxin vs Bisoprolol for Heart Rate Control in Atrial Fibrillation on Patient-Reported Quality of Life: The RATE-AF Randomized Clinical Trial. ](https://pubmed.ncbi.nlm.nih.gov/33351042/) Kotecha D, Bunting KV, Gill SK, Mehta S, Stanbury M, Jones JC, Haynes S, Calvert MJ, Deeks JJ, Steeds RP, Strauss VY, Rahimi K, Camm AJ, Griffith M, Lip GYH, Townend JN, Kirchhof P; Rate Control Therapy Evaluation in Permanent Atrial Fibrillation (RATE-AF) Team.Kotecha D, et al.JAMA. 2020 Dec 22;324(24):2497-2508. doi: 10.1001/jama.2020.23138.JAMA. 2020.PMID: 33351042Free PMC article.Clinical Trial. * [ Landiolol: A Review in Tachyarrhythmias. ](https://pubmed.ncbi.nlm.nih.gov/29470800/) Syed YY.Syed YY.Drugs. 2018 Mar;78(3):377-388. doi: 10.1007/s40265-018-0883-9.Drugs. 2018.PMID: 29470800Review. * [ Catheter ablation for atrial fibrillation in heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials. ](https://pubmed.ncbi.nlm.nih.gov/30646857/) AlTurki A, Proietti R, Dawas A, Alturki H, Huynh T, Essebag V.AlTurki A, et al.BMC Cardiovasc Disord. 2019 Jan 15;19(1):18. doi: 10.1186/s12872-019-0998-2.BMC Cardiovasc Disord. 2019.PMID: 30646857Free PMC article. 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