Revised: March 22, 2026
Accepted: April 14, 2026
Published online: August 26, 2026
Processing time: 182 Days and 6.9 Hours
In this editorial, we comment on the article by Hu et al published in the World Journal of Cardiology. Cardiac rhythm disturbances are common in sepsis and range from sinus tachycardia to more serious ventricular arrhythmias. These changes do not occur in isolation; they reflect the combined impact of inflammation, metabolic stress, and persistent adrenergic stimulation on myocardial tissue. Although landiolol has been used primarily to control heart rate, emerging experimental data suggest that its role may extend beyond simple chronotropic modulation. In a septic model, landiolol was associated with a lower ventricular arrhythmia burden and with changes in connexin-43 and NaV1.5, two proteins central to electrical conduction. These findings raise the possibility that selective β1-blockade may influence the arrhythmogenic substrate itself. Further studies are needed to clarify whether modulation of electrical remodeling can translate into meaningful clinical benefit in carefully selected patients.
Core Tip: Ventricular arrhythmias in sepsis may not be only a consequence of elevated heart rate, but rather the result of inflammation-driven electrical instability within the myocardium. Experimental data suggest that landiolol may influence this process by affecting key conduction proteins, including connexin-43 and NaV1.5. This perspective shifts the focus from simple rate control toward potential modulation of the arrhythmogenic substrate, highlighting the need for more targeted clinical investigation.