title: Pre-cardiac transplant amiodarone use is not associated with postoperative mortality: An updated meta-analysis.
abstract: BACKGROUND
  Amiodarone remains the preferred agent for the treatment and prevention of life-threatening ventricular arrhythmias in patients with end-stage heart failure. While several reports suggest that pre-operative amiodarone exposure worsens outcomes in heart transplant recipients, other studies have failed to validate this relationship. We sought to clarify this issue by performing a meta-analysis of the available literature surrounding this topic.
  
  
  METHODS
  We searched Medline, SCOPUS and the Cochrane Central Register of Controlled Trials through December 15th 2016, as well as proceedings from related conferences over the prior 3years. Included studies evaluated patients undergoing cardiac transplantation who had received pre-transplant amiodarone and reported postoperative mortality. Outcomes were pooled using a Hartung-Knapp random-effects model producing odds ratios (OR) and 95% confidence intervals (CI). Statistical heterogeneity was evaluated using the Cochrane Q statistic p-value and I2value. Publication bias was assessed by visual inspection of funnel plots and using Egger's weighted regression statistic.
  
  
  RESULTS
  Nine studies including 16,509 participants were included in the overall analysis. Use of pre-transplant amiodarone was not associated with an increase in postoperative mortality versus control (OR 1.38, 95% 0.8 to 2.36). Moderate statistical heterogeneity was present (I2=45.8%, p=0.06); visual inspection of funnel plot analysis did not suggest publication bias. No association was noted between a longer duration of follow-up and higher odds of mortality with amiodarone use (p=0.91).
  
  
  CONCLUSIONS
  Meta-analysis of the available evidence suggests that pre-operative amiodarone exposure does not increase mortality in cardiac transplant recipients.
authors.affiliation: Department of Pharmacy, NewYork Presbyterian Columbia University Irving Medical Center, New York, NY, United States. Electronic address: dj2414@cumc.columbia.edu.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Jennings
authors.affiliation: School of Pharmacy, University of Connecticut, Storrs, CT, United States.
authors.forename: William L
authors.initials: WL
authors.lastname: Baker
mesh_terms: D000638:Amiodarone / Q000008:administration & dosage* / Q000009:adverse effects; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D018849:Controlled Clinical Trials as Topic / Q000379:methods; D016027:Heart Transplantation / Q000401:mortality* / Q000639:trends; D006801:Humans; D009026:Mortality / Q000639:trends; D011183:Postoperative Complications / Q000139:chemically induced / Q000401:mortality* / Q000517:prevention & control; D011300:Preoperative Care / Q000401:mortality* / Q000639:trends
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone
keywords: Amiodarone; Cardiovascular drugs; Heart transplantation; Meta-analysis; Surgery