title: 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.
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).
  
  
  OBJECTIVE
  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).
  
  
  CONCLUSIONS
  Long-term use of amiodarone in patients before HTX significantly reduces early post-transplant AF and is not associated with increased mortality after HTX.
authors.affiliation: Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Rivinius
authors.affiliation: Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Helmschrott
authors.affiliation: Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Arjang
authors.initials: A
authors.lastname: Ruhparwar
authors.affiliation: Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Bastian
authors.initials: B
authors.lastname: Schmack
authors.affiliation: Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Erbel
authors.affiliation: Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Gleissner
authors.affiliation: Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Akhavanpoor
authors.affiliation: Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Frankenstein
authors.affiliation: Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Fabrice F
authors.initials: FF
authors.lastname: Darche
authors.affiliation: Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Schweizer
authors.affiliation: Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Dierk
authors.initials: D
authors.lastname: Thomas
authors.affiliation: Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Ehlermann
authors.affiliation: Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors.forename: Tom
authors.initials: T
authors.lastname: Bruckner
authors.affiliation: Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.affiliation: Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Andreas O
authors.initials: AO
authors.lastname: Doesch
mesh_terms: D000328:Adult; D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000517:prevention & control*; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*
chemical_list: D000889:Anti-Arrhythmia Agents; D007166:Immunosuppressive Agents; D000638:Amiodarone
keywords: amiodarone; atrial fibrillation; heart failure; heart transplantation; mortality