Amiodarone for the Management of Acute Atrial Arrhythmias After Lung Transplant

Purpose: Dosing, safety, and outcomes of amiodarone in acute post-operative atrial arrhythmias (POAAs) after lung transplantation are not well understood. Current literature suggests amiodarone may increase mortality in lung transplant recipients (LTRs). This study described outcomes associated with amiodarone use in POAAs after lung transplantation. Methods: This single-center, retrospective cohort study analyzed LTRs who received amiodarone after developing a POAA within 30 days of transplant surgery and prior to hospital discharge from their index transplant admission. Primary safety outcomes included mortality and the incidence of adverse drug reactions (ADRs). Secondary efficacy outcomes included time to normal sinus rhythm (NSR) attainment, intensive care unit (ICU) and hospital length of stay, and atrial arrhythmia (AA) recurrence. Results: A total of 131 LTRs who developed an acute POAA received amiodarone. The 1-year mortality did not differ between this cohort and our overall lung transplant population, and ADR incidence was similar to that observed in non-LTRs. The median time to NSR attainment was 28 hours after amiodarone initiation; ICU and hospital lengths of stay were 4.5 and 18.5 days, respectively; and AA recurrence occurred in 32.8% of patients. Conclusion: The findings of this study suggest that amiodarone use may be safe in LTRs with acute atrial arrhythmias, and may also effectively terminate acute POAAs in this population.