Amiodarone use may reduce survival in continuous‐flow left ventricular assist device recipients

For patients who have undergone continuous‐flow left ventricular assist device (CF‐LVAD) implantation, treatment with amiodarone may do more harm than good, with a recent study showing that it contributes to increased risk of mortality.

The retrospective study involved 480 patients (mean age 58 years, 81 percent men) with a CF‐LVAD. Two‐thirds of the population were White, and about half had ischemic cardiomyopathy. The median duration of LVAD support was 479 days. A total of 170 patients (35.4 percent) were on chronic amiodarone therapy at the time of LVAD implant, whereas 310 (64.6 percent) were not (control).

Following implantation, amiodarone was discontinued in 70 percent of users and initiated in 36 percent of nonusers. The primary outcome of all‐cause mortality over the follow‐up period was significantly higher in the amiodarone group than in the control group (32.9 percent vs 29.6 percent; p=0.008).

Similar results were obtained in a propensity score matched cohort of 122 patients in the amiodarone group and 122 in the control group (p=0.04). Multivariable Cox regression analysis showed that amiodarone use at baseline was associated with a 68-percent increase in all‐cause mortality risk (hazard ratio, 1.68, 95 percent confidence interval, 1.1–2.5; p=0.01).

With regard to the secondary outcomes, the amiodarone group showed a higher incidence of ventricular arrythmia (51 percent vs 37 percent; p=0.003) but similar rates of all‐cause and cardiac hospitalizations and incidence of atrial arrhythmia compared with the control group.

These findings underscore the importance of reconsidering the management strategy for atrial and ventricular arrythmias in patients undergoing CF‐LVAD implantation.