Comparison of posttransplant outcomes in patients with no, acute, or chronic amiodarone use before heart transplantation

Abstract

BackgroundMajor concerns about the safety of pretransplant amiodarone use have been raised. As a result of its long half-life, the cardiac allograft is exposed to amiodarone posing potential risks such as bradycardia, requirement for pacemaker implantation, or increased mortality after heart transplantation (HTX).ObjectiveThe aim of this study is to investigate the posttransplant outcomes of patients with no, acute, or chronic amiodarone use before HTX.MethodsThis retrospective single-center study included 530 adult patients who received HTX between 06/1989 and 12/2012. Patients were stratified by their amiodarone therapy before HTX: no continuous amiodarone use (≤90 days before HTX), acute amiodarone use (≤90 days before HTX), and chronic amiodarone use (>90 days before HTX). Differences between the 3 groups in demographics, posttransplant medication, echocardiographic features, heart rates including occurrences of bradycardia, permanent pacemaker implantation, atrial fibrillation (AF), and survival were analyzed.ResultsA total of 412 patients (77.7%) were in the “no amiodarone” group, 23 patients (4.4%) in the “acute amiodarone” group, and 95 patients (17.9%) in the “chronic amiodarone” group. Left ventricular ejection fraction (P=0.5819), heart rates including occurrence of bradycardia during posttransplant week 1 (P=0.0979 and P=0.2695), week 2 (P=0.1214 and P=0.8644), week 3 (P=0.1033 and P=0.8894), and week 4 (P=0.2892 and P=0.8644), permanent pacemaker implantation within 30-day (P=0.8644), or overall follow-up after HTX (P=0.8664) were not significant between groups. Patients with chronic pretransplant amiodarone therapy had the lowest rate of early posttransplant AF (P=0.0065). There was no statistically significant difference between groups in 30-day (P=0.8656), 1-year (P=1.0000), 2-year (P=0.8763), 5-year (P=0.5174), or overall posttransplant follow-up mortality (P=0.1936).ConclusionAdministration of acute or chronic pretransplant amiodarone was not related to an increased occurrence of bradycardia, requirement for permanent pacemaker implantation, or mortality after HTX. Importantly, chronic amiodarone use effectively reduced early AF after HTX, whereas acute amiodarone use showed no such effect.

Elevated pre‐transplant pulmonary vascular resistance is associated with early post‐transplant atrial fibrillation and mortality

“…Finally, our results should be considered as hypothesis generating, especially in terms of post‐transplant survival as multiple factors may affect survival after HTX. Thus, to confirm our results, further large prospective multi‐centre trials are preferable to analyse the influence of an elevated pre‐transplant PVR on outcomes after HTX …”

“…Furthermore, the used study design has the advantage of a standardized centre‐specific pre‐transplant, peri‐transplant, and post‐transplant course of treatment and follow‐up of patients after HTX. These positive aspects should be balanced against potential disadvantages …”

“…Written informed consent was obtained from patients for inclusion in the Heidelberg HTX registry allowing the clinical and scientific use of data. According to the ethical approval, no additional written informed consent was required for this observational retrospective single‐centre study as only routine clinical data were used …”

“…The following six clinically relevant parameters were included based on a predetermined model: native PVR before HTX ≥ 300 dyn·s·cm −5 (≥3.75 Wood units), recipient age (>60.0 years), coronary artery disease, previous open‐heart surgery, donor age (>40.0 years), and ischaemic time (≥240 min). In order to avoid biased regression coefficients and to ensure a stable number of events (deceased patients) per analysed variable, no further clinically less relevant parameters were included in this multivariate analysis …”

“…After discharge, patients were followed up monthly within the first 6 months after HTX, then bimonthly between months 6 and 12 after HTX, and thereafter usually three to four times annually. [28][29][30][31][32][33][34][35][36]…”