Kansas City Heart Rhythm Institute Overland Park KS.
Department of Cardiothoracic Surgery University of Louisville Louisville KY.
J Am Heart Assoc. 2022 Jun 7;11(11):e023762. doi: 10.1161/JAHA.121.023762. Epub 2022 Jun 3.
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 amiodarone 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 (=0.008). Similar results were noted in the propensity-matched group (log-rank, =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]; =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.
在晚期心力衰竭患者中，常出现心房和心室心律失常，胺碘酮是连续流左心室辅助装置（CF-LVAD）受者中最常用的抗心律失常药物。本研究旨在评估 CF-LVAD 患者使用胺碘酮对长期全因死亡率的影响。
在 5 个中心进行了回顾性多中心 CF-LVAD 研究，纳入了 2007 年至 2015 年所有 CF-LVAD 植入患者。根据 CF-LVAD 植入前胺碘酮的使用情况对患者进行分层。还评估了 CF-LVAD 植入后胺碘酮的额外使用。主要结局是长期随访期间的全因死亡率。使用 Kaplan-Meier 曲线评估生存结果。使用多变量 Cox 回归确定结局的预测因素。进行倾向匹配以解决基线差异。共纳入 480 例 CF-LVAD 患者（年龄 58±13 岁，81%为男性）。其中，170 例（35.4%）在 CF-LVAD 植入时接受慢性胺碘酮治疗，310 例（64.6%）未接受胺碘酮治疗。随访期间全因死亡率在胺碘酮组为 32.9%，未用胺碘酮组为 29.6%（=0.008）。在倾向匹配组中也观察到类似结果（对数秩检验，=0.04）。多变量 Cox 回归分析显示，基线时使用胺碘酮与全因死亡率独立相关（危险比，1.68[95%CI，1.1-2.5]；=0.01）。
胺碘酮的使用与 CF-LVAD 受者全因死亡率的显著增加相关。早期干预心律失常以避免长期暴露于胺碘酮可能改善 CF-LVAD 受者的长期预后，需要进一步研究。
