Landiolol for Rate Control in Decompensated Heart Failure Due to Atrial Fibrillation

Procedure: 1. Eligible patients with signed consent will be enrolled. 2. Baseline transthoracic echocardiography, laboratory testing, evaluation of subjective dyspnea, lung water by ultrasound, chest x-ray, hemodynamic monitoring (details below) 3. Randomisation 1:1 to standard therapy vs. intensive heart rate control 4. Two hours of therapy with continous hemodynamic monitoring (blood pressure by arterial line, cardiac output and stroke volume non-invasively by bioreactance) 1. Standard therapy (oral or intravenous beta-blockers other than landiolol while avoiding hypotension or deterioration of hemodynamics, according to the preference of the physician) with a bolus of 250-500mg of digoxin 2. Intensive heart rate control with the goal to achieve heart rate \<115 during the first the hours, preferentially with continuous infusion of landiolol and a bolus of 250-500mg of digoxin. The dose will be titrated according to the actual heart rate and hemodynamic parameters (blood pressure, cardiac index, stroke volume index). If possible, in both groups, electric cardioversion will be preferentially delayed during the first 2 hours. Both groups will receive standard therapy of acute heart failure (diuretics, inotropes if needed-preferentially milrinone or levosimendan, nitrates..) 5. At 2 hours: evaluation of patients subjective dyspnea (primary clinical endpoint), heart rate (primary endpoint), hearth rhythm and hemodynamics 6. After 2 hours, both groups can be treated according to the preference of the physician. 7. Symptoms, heart rate control, hemodynamics and lung congestion will be reevaluated at 12 and 48 hours 8. The study protocol will end after 48 hours.