TY - JOUR
T1 - Amiodarone Use and All-Cause Mortality in Patients With a Continuous-Flow Left Ventricular Assist Device
AU - Gopinathannair, Rakesh
AU - Pothineni, Naga Venkata K.
AU - Trivedi, Jaimin R.
AU - Roukoz, Henri
AU - Cowger, Jennifer
AU - Ahmed, Mustafa M.
AU - Bhan, Adarsh
AU - Ravichandran, Ashwin K.
AU - Bhat, Geetha
AU - Ahmad, Amin Al
AU - Natale, Andrea
AU - Biase, Luigi Di
AU - Slaughter, Mark S.
AU - Lakkireddy, Dhanunjaya
N1 - Publisher Copyright:
© 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2022/6/7
Y1 - 2022/6/7
N2 - BACKGROUND: Atrial and ventricular arrhythmias are commonly encountered in patients with advanced heart failure, with amiodarone being the most commonly used antiarrhythmic drug in continuous-flow left ventricular assist device (CF-LVAD) recipients. The purpose of this study was to assess the impact of amiodarone use on long-term all-cause mortality in ptients with a CF-LVAD. METHODS AND RESULTS: A retrospective multicenter study of CF-LVAD was conducted at 5 centers including all CF-LVAD implants from 2007 to 2015. Patients were stratified based on pre–CF-LVAD implant amiodarone use. Additional use of ami-odarone after CF-LVAD implantation was also evaluated. Primary outcome was all-cause mortality during long-term follow-up. Kaplan-Meier curves were used to assess survival outcomes. Multivariable Cox regression was used to identify predictors of outcomes. Propensity matching was done to address baseline differences. A total of 480 patients with a CF-LVAD (aged 58±13 years, 81% men) were included. Of these, 170 (35.4%) were on chronic amiodarone therapy at the time of CF-LVAD implant, and 310 (64.6%) were not on amiodarone. Rate of all-cause mortality over the follow-up period was 32.9% in the amiodarone group compared with 29.6% in those not on amiodarone (P=0.008). Similar results were noted in the propensity-matched group (log-rank, P=0.04). On multivariable Cox regression analysis, amiodarone use at baseline was independently associated with all-cause mortality (hazard ratio, 1.68 [95% CI, 1.1–2.5]; P=0.01). CONCLUSIONS: Amiodarone use was associated with significantly increased rates of all-cause mortality in CF-LVAD recipients. Earlier interventions for arrhythmias to avoid long-term amiodarone exposure may improve long-term outcomes in CF-LVAD recipients and needs further study.
AB - BACKGROUND: Atrial and ventricular arrhythmias are commonly encountered in patients with advanced heart failure, with amiodarone being the most commonly used antiarrhythmic drug in continuous-flow left ventricular assist device (CF-LVAD) recipients. The purpose of this study was to assess the impact of amiodarone use on long-term all-cause mortality in ptients with a CF-LVAD. METHODS AND RESULTS: A retrospective multicenter study of CF-LVAD was conducted at 5 centers including all CF-LVAD implants from 2007 to 2015. Patients were stratified based on pre–CF-LVAD implant amiodarone use. Additional use of ami-odarone after CF-LVAD implantation was also evaluated. Primary outcome was all-cause mortality during long-term follow-up. Kaplan-Meier curves were used to assess survival outcomes. Multivariable Cox regression was used to identify predictors of outcomes. Propensity matching was done to address baseline differences. A total of 480 patients with a CF-LVAD (aged 58±13 years, 81% men) were included. Of these, 170 (35.4%) were on chronic amiodarone therapy at the time of CF-LVAD implant, and 310 (64.6%) were not on amiodarone. Rate of all-cause mortality over the follow-up period was 32.9% in the amiodarone group compared with 29.6% in those not on amiodarone (P=0.008). Similar results were noted in the propensity-matched group (log-rank, P=0.04). On multivariable Cox regression analysis, amiodarone use at baseline was independently associated with all-cause mortality (hazard ratio, 1.68 [95% CI, 1.1–2.5]; P=0.01). CONCLUSIONS: Amiodarone use was associated with significantly increased rates of all-cause mortality in CF-LVAD recipients. Earlier interventions for arrhythmias to avoid long-term amiodarone exposure may improve long-term outcomes in CF-LVAD recipients and needs further study.
KW - amiodarone
KW - arrhythmias
KW - left ventricular assist device
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=85132389638&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85132389638&partnerID=8YFLogxK
U2 - 10.1161/JAHA.121.023762
DO - 10.1161/JAHA.121.023762
M3 - Article
C2 - 35656998
AN - SCOPUS:85132389638
SN - 2047-9980
VL - 11
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 11
M1 - e023762
ER -