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Published on: October 12, 2014
The effect of chronic amiodarone therapy before transplantation on early cardiac allograft function
P Macdonald1, R Hackworthy, A Keogh
1Cardiopulmonary Transplant Unit, St. Vincent's Hospital, Sydney, Australia.
Insights
Chronic amiodarone therapy before heart transplantation did not adversely affect early cardiac allograft function or clinical outcomes. Patients on amiodarone showed longer atrial pacing needs but similar recovery times, suggesting it is not a contraindication.
Area of Science:
- Cardiology
- Transplantation Medicine
- Pharmacology
Background:
- Amiodarone's long half-life raises concerns about its impact on early cardiac allograft function post-heart transplantation.
- Potential for delayed patient recovery due to chronic amiodarone use before transplantation.
Purpose of the Study:
- To investigate the effects of pre-transplant amiodarone therapy on early cardiac allograft function and patient recovery after heart transplantation.
- To determine if amiodarone use is a contraindication for heart transplantation.
Main Methods:
- Retrospective analysis of 50 heart transplant recipients (September 1988 - September 1989).
- Comparison of outcomes between 19 patients on amiodarone and 31 patients not on amiodarone.
- Assessment of early allograft function, pacing requirements, and clinical outcomes.
Main Results:
- Patients on amiodarone had significantly lower heart rates and required longer atrial pacing post-transplant.
- No detectable adverse effect of amiodarone on early allograft inotropic function or overall clinical outcome.
- Mean hospital discharge time was similar between groups.
Conclusions:
- Pre-transplant amiodarone therapy does not appear to negatively impact early cardiac allograft function or clinical outcomes.
- Amiodarone therapy should not be considered a contraindication for heart transplantation.
- Further research may explore optimal management strategies for amiodarone patients undergoing transplantation.
Abstract:
Because of its long half-life, there has been concern that chronic amiodarone therapy before heart transplantation may adversely affect early cardiac allograft function and delay patient recovery. We retrospectively analyzed the outcome of the last 50 patients undergoing heart transplantation at our institution (between September 1988 and September 1989). Nineteen patients had been taking amiodarone at the time of transplantation (mean daily dose, 247 +/- 31 mg; mean duration of treatment, 9.0 +/- 2.2 months). These patients did not differ from the remaining 31 patients with respect to age, sex, or cause of disease. Donor organ ischemic time was also similar in the two groups (158 +/- 11 vs 153 +/- 10 minutes, NS). Patients who had received amiodarone before transplantation had significantly lower heart rates at 1 and 4 weeks after transplantation. They required atrial pacing for a longer time after transplantation compared with the remaining patients (7.3 +/- 1.4 vs 3.4 +/- 0.8 days, p less than 0.02). There was, however, no detectable effect of prior amiodarone therapy either on early allograft inotropic function or on clinical outcome. The mean time to hospital discharge was similar in the two groups. We believe that acceptance for heart transplantation should not be regarded as a contraindication to amiodarone therapy.
