title: Relationship of amiodarone to postoperative complications of transthoracic implantation of automatic implantable cardioverter defibrillators.
abstract: The purpose of this study is to report the results and complications associated with transthoracic placement of an implantable defibrillator and their relationship to amiodarone, and to identify clinical predictors of complications. There were 159 men and 41 women. The mean patients age was 61 +/- 11 years, and the mean ejection fraction was 0.33 +/- 0.14. Fifty one percent of patients developed complications including death in 14 patients (7%). Variables which differed in patients who died and those that did not were age, ejection fraction and New York heart failure classifications. Postoperative mortality was unrelated to amiodarone therapy. Twenty patients (10%) developed pneumonia and 15 patients (7.5%) developed respiratory failure. Clinical variables associated with the development of respiratory failure were age, amiodarone therapy and a prior history of pulmonary disease. Patients receiving amiodarone had a higher incidence of an elevated defibrillation threshold (> or = 25 joules) as compared with those not being treated with amiodarone. Clinical factors associated with an elevated defibrillation threshold were a history of a myocardial infarction, prior bypass surgery, and amiodarone. The results of this study demonstrate that placement of an implantable defibrillator using a transthoracic approach is associated with a high incidence of complications. Amiodarone therapy is associated with an increased incidence of pneumonia, respiratory failure, and elevated defibrillation thresholds.
authors.affiliation: Division of Cardiology, University of Michigan Medical Center, Ann Arbor, USA.
authors.forename: H
authors.initials: H
authors.lastname: Calkins
authors.forename: M
authors.initials: M
authors.lastname: Bahu
authors.forename: Y
authors.initials: Y
authors.lastname: Shyr
authors.forename: A
authors.initials: A
authors.lastname: Schork
authors.forename: S
authors.initials: S
authors.lastname: Bolling
authors.forename: W
authors.initials: W
authors.lastname: Kou
authors.forename: M
authors.initials: M
authors.lastname: Kirsch
authors.forename: F
authors.initials: F
authors.lastname: Morady
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D013909:Thorax
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone