Atrial arrhythmias after lung and heart-lung transplant: effects on short-term mortality and the influence of amiodarone.

BACKGROUND: The incidence and effect of atrial fibrillation or flutter (AF) after lung transplant are variable. An effect of pharmacologic treatment on outcomes is undetermined.
METHODS: One hundred thirty-seven consecutive lung or heart-lung transplant patients were reviewed retrospectively. Uni- and multivariate analyses were performed to determine statistically significant risk factors for AF and short-term mortality.
RESULTS: AF occurred in 45.0% of patients within 26 days. By univariate analysis, male gender was predictive of AF (hazard ratio [HR] = 2.25, 95% confidence interval [CI] 1.21 to 4.20, p = 0.011). Mortality within 200 days occurred in 36 of 137 (22.6%) patients. Those with AF had higher mortality than those without AF (27 of 62 [43.5%] vs 9 of 75 [12%]; p < 0.0001). Twenty-four of the 38 (63.1%) patients treated with amiodarone died, whereas 3 of 26 (11.5%) patients treated without amiodarone died (p < 0.0001). Mortality was similar among patients without AF, and those with AF not receiving amiodarone (9 of 75 [12%] vs 3 of 26 [11.5%], p = 1.00). By multivariate analysis, chronic obstructive pulmonary disease (HR = 0.395, CI 0.175 to 0.892, p = 0.025), primary pulmonary hypertension (HR = 7.245, CI 1.89 to 27.84, p = 0.0039), and use of amiodarone (HR = 2.967, CI 1.187 to 7.415, p = 0.020) were associated with death. Amiodarone was shown to be a significant statistical moderator (p < 0.0001) and mediator (p < 0.001) of mortality in AF patients.
CONCLUSIONS: There was a high incidence of AF after lung or heart-lung transplant, and a significant increase in mortality in AF patients treated with amiodarone. In patients with severe lung pathology, amiodarone pulmonary toxicity may be more common than previously known, and may be a significant contributor to mortality. Amiodarone use should be restricted in the lung transplant patient population.