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Multicenter Study
. 2022 Jun 7;11(11):e023762.
doi: 10.1161/JAHA.121.023762. Epub 2022 Jun 3.

Amiodarone Use and All-Cause Mortality in Patients With a Continuous-Flow Left Ventricular Assist Device

Rakesh Gopinathannair  1 , Naga Venkata K Pothineni  1 , Jaimin R Trivedi  2 , Henri Roukoz  3 , Jennifer Cowger  4 , Mustafa M Ahmed  5 , Adarsh Bhan  6 , Ashwin K Ravichandran  7 , Geetha Bhat  8 , Amin Al Ahmad  9 , Andrea Natale  9 , Luigi Di Biase  10 , Mark S Slaughter  2 , Dhanunjaya Lakkireddy  1
Affiliations
Multicenter Study

Amiodarone Use and All-Cause Mortality in Patients With a Continuous-Flow Left Ventricular Assist Device

Rakesh Gopinathannair et al. J Am Heart Assoc. .

Abstract

Background Atrial and ventricular arrhythmias are commonly encountered in patients with advanced heart failure, with amiodarone being the most commonly used antiarrhythmic drug in continuous-flow left ventricular assist device (CF-LVAD) recipients. The purpose of this study was to assess the impact of amiodarone use on long-term all-cause mortality in ptients with a CF-LVAD. Methods and Results A retrospective multicenter study of CF-LVAD was conducted at 5 centers including all CF-LVAD implants from 2007 to 2015. Patients were stratified based on pre-CF-LVAD implant amiodarone use. Additional use of amiodarone after CF-LVAD implantation was also evaluated. Primary outcome was all-cause mortality during long-term follow-up. Kaplan-Meier curves were used to assess survival outcomes. Multivariable Cox regression was used to identify predictors of outcomes. Propensity matching was done to address baseline differences. A total of 480 patients with a CF-LVAD (aged 58±13 years, 81% men) were included. Of these, 170 (35.4%) were on chronic amiodarone therapy at the time of CF-LVAD implant, and 310 (64.6%) were not on amiodarone. Rate of all-cause mortality over the follow-up period was 32.9% in the amiodarone group compared with 29.6% in those not on amiodarone (P=0.008). Similar results were noted in the propensity-matched group (log-rank, P=0.04). On multivariable Cox regression analysis, amiodarone use at baseline was independently associated with all-cause mortality (hazard ratio, 1.68 [95% CI, 1.1-2.5]; P=0.01). Conclusions Amiodarone use was associated with significantly increased rates of all-cause mortality in CF-LVAD recipients. Earlier interventions for arrhythmias to avoid long-term amiodarone exposure may improve long-term outcomes in CF-LVAD recipients and needs further study.

Keywords: amiodarone; arrhythmias; left ventricular assist device; mortality.

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Figures

Figure 1
Figure 1. Kaplan‐Meier analysis showing increased all‐cause mortality during follow‐up in patients with a left ventricular assist device stratified by use of amiodarone at baseline (amiodarone group [1] vs no‐amiodarone group [0]; log‐rank, P=0.008).
VAD indicates ventricular assist device.
Figure 2
Figure 2. Kaplan‐Meier analysis of all‐cause mortality in patients with a left ventricular assist device (LVAD) stratified by before and after left ventricular assist device use of amiodarone (log‐rank, P=0.03).
(1) No amiodarone use before or after LVAD. (2) No amiodarone use before LVAD, was on amiodarone after LVAD. (3) Amiodarone use at baseline (before LVAD); no amiodarone use after LVAD. (4) Amiodarone use before and after LVAD. VAD indicates ventricular assist device.
Figure 3
Figure 3. Kaplan‐Meier analysis showing increased all‐cause mortality during follow‐up in the propensity‐matched left ventricular assist device cohort stratified by use of amiodarone at baseline (amiodarone group [1] vs no‐amiodarone group [0]; log‐rank, P=0.04).
VAD indicates ventricular assist device.
See this image and copyright information in PMC

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