title: Atrial arrhythmias after lung and heart-lung transplant: effects on short-term mortality and the influence of amiodarone.
abstract: BACKGROUND
  The incidence and effect of atrial fibrillation or flutter (AF) after lung transplant are variable. An effect of pharmacologic treatment on outcomes is undetermined.
  
  
  METHODS
  One hundred thirty-seven consecutive lung or heart-lung transplant patients were reviewed retrospectively. Uni- and multivariate analyses were performed to determine statistically significant risk factors for AF and short-term mortality.
  
  
  RESULTS
  AF occurred in 45.0% of patients within 26 days. By univariate analysis, male gender was predictive of AF (hazard ratio [HR] = 2.25, 95% confidence interval [CI] 1.21 to 4.20, p = 0.011). Mortality within 200 days occurred in 36 of 137 (22.6%) patients. Those with AF had higher mortality than those without AF (27 of 62 [43.5%] vs 9 of 75 [12%]; p < 0.0001). Twenty-four of the 38 (63.1%) patients treated with amiodarone died, whereas 3 of 26 (11.5%) patients treated without amiodarone died (p < 0.0001). Mortality was similar among patients without AF, and those with AF not receiving amiodarone (9 of 75 [12%] vs 3 of 26 [11.5%], p = 1.00). By multivariate analysis, chronic obstructive pulmonary disease (HR = 0.395, CI 0.175 to 0.892, p = 0.025), primary pulmonary hypertension (HR = 7.245, CI 1.89 to 27.84, p = 0.0039), and use of amiodarone (HR = 2.967, CI 1.187 to 7.415, p = 0.020) were associated with death. Amiodarone was shown to be a significant statistical moderator (p < 0.0001) and mediator (p < 0.001) of mortality in AF patients.
  
  
  CONCLUSIONS
  There was a high incidence of AF after lung or heart-lung transplant, and a significant increase in mortality in AF patients treated with amiodarone. In patients with severe lung pathology, amiodarone pulmonary toxicity may be more common than previously known, and may be a significant contributor to mortality. Amiodarone use should be restricted in the lung transplant patient population.
authors.affiliation: Cardiology Division, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
authors.forename: Ijeoma
authors.initials: I
authors.lastname: Isiadinso
authors.forename: Arnold B
authors.initials: AB
authors.lastname: Meshkov
authors.forename: John
authors.initials: J
authors.lastname: Gaughan
authors.forename: Paul
authors.initials: P
authors.lastname: Sandhu
authors.forename: Sharon
authors.initials: S
authors.lastname: Lim
authors.forename: Francis
authors.initials: F
authors.lastname: Cordova
authors.forename: Gerard
authors.initials: G
authors.lastname: Criner
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000009:adverse effects*; D000704:Analysis of Variance; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D001282:Atrial Flutter / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D016041:Heart-Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D015994:Incidence; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone