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. 2016 Feb 16:10:677-86.
doi: 10.2147/DDDT.S96126. eCollection 2016.

Long-term use of amiodarone before heart transplantation significantly reduces early post-transplant atrial fibrillation and is not associated with increased mortality after heart transplantation

Rasmus Rivinius  1 , Matthias Helmschrott  1 , Arjang Ruhparwar  2 , Bastian Schmack  2 , Christian Erbel  1 , Christian A Gleissner  1 , Mohammadreza Akhavanpoor  1 , Lutz Frankenstein  1 , Fabrice F Darche  1 , Patrick A Schweizer  1 , Dierk Thomas  1 , Philipp Ehlermann  1 , Tom Bruckner  3 , Hugo A Katus  1 , Andreas O Doesch  1
Affiliations

Long-term use of amiodarone before heart transplantation significantly reduces early post-transplant atrial fibrillation and is not associated with increased mortality after heart transplantation

Rasmus Rivinius et al. Drug Des Devel Ther. .

Abstract

Background: Amiodarone is a frequently used antiarrhythmic drug in patients with end-stage heart failure. Given its long half-life, pre-transplant use of amiodarone has been controversially discussed, with divergent results regarding morbidity and mortality after heart transplantation (HTX).

Aim: The aim of this study was to investigate the effects of long-term use of amiodarone before HTX on early post-transplant atrial fibrillation (AF) and mortality after HTX.

Methods: Five hundred and thirty patients (age ≥18 years) receiving HTX between June 1989 and December 2012 were included in this retrospective single-center study. Patients with long-term use of amiodarone before HTX (≥1 year) were compared to those without long-term use (none or <1 year of amiodarone). Primary outcomes were early post-transplant AF and mortality after HTX. The Kaplan-Meier estimator using log-rank tests was applied for freedom from early post-transplant AF and survival.

Results: Of the 530 patients, 74 (14.0%) received long-term amiodarone therapy, with a mean duration of 32.3±26.3 months. Mean daily dose was 223.0±75.0 mg. Indications included AF, Wolff-Parkinson-White syndrome, ventricular tachycardia, and ventricular fibrillation. Patients with long-term use of amiodarone before HTX had significantly lower rates of early post-transplant AF (P=0.0105). Further, Kaplan-Meier analysis of freedom from early post-transplant AF showed significantly lower rates of AF in this group (P=0.0123). There was no statistically significant difference between patients with and without long-term use of amiodarone prior to HTX in 1-year (P=0.8596), 2-year (P=0.8620), 5-year (P=0.2737), or overall follow-up mortality after HTX (P=0.1049). Moreover, Kaplan-Meier survival analysis showed no statistically significant difference in overall survival (P=0.1786).

Conclusion: Long-term use of amiodarone in patients before HTX significantly reduces early post-transplant AF and is not associated with increased mortality after HTX.

Keywords: amiodarone; atrial fibrillation; heart failure; heart transplantation; mortality.

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Figures

Figure 1
Figure 1
Indications for pre-transplant use of amiodarone. Notes: Indications for long-term amiodarone therapy were atrial fibrillation in ten patients (13.5%), Wolff–Parkinson–White syndrome in one patient (1.4%), ventricular tachycardia in 57 patients (77.0%), and ventricular fibrillation in six patients (8.1%).
Figure 2
Figure 2
Kaplan–Meier estimator (freedom from early post-transplant atrial fibrillation). Note: Freedom from early post-transplant atrial fibrillation (≤30 days after HTX) in patients with/without pre-transplant use of amiodarone. Abbreviations: HTX, heart transplantation; AF, atrial fibrillation.
Figure 3
Figure 3
Kaplan–Meier estimator (overall follow-up survival). Note: Survival of patients with/without pre-transplant use of amiodarone. Abbreviation: HTX, heart transplantation.
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References

    1. Saravanan P, Davidson NC. Risk assessment for sudden cardiac death in dialysis patients. Circ Arrhythm Electrophysiol. 2010;3(5):553–559. - PubMed
    1. Pedersen CT, Kay GN, Kalman J, et al. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Heart Rhythm. 2014;11(10):166–196. - PubMed
    1. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64(21):1–76. - PubMed
    1. Jennings DL, Martinez B, Montalvo S, Lanfear DE. Impact of pre-implant amiodarone exposure on outcomes in cardiac transplant recipients. Heart Fail Rev. 2015;20(5):573–578. - PubMed
    1. Chin C, Feindel C, Cheng D. Duration of preoperative amiodarone treatment may be associated with postoperative hospital mortality in patients undergoing heart transplantation. J Cardiothorac Vasc Anesth. 1999;13(5):562–566. - PubMed

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