open access

Vol 22, No 6 (2015)
Original articles
Published online: 2015-12-30
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Mortality risk of long-term amiodarone therapy for atrial fibrillation patients without structural heart disease

Dingxin Qin, George Leef, Mian Bilal Alam, Rohit Rattan, Mohamad Bilal Munir, Divyang Patel, Furqan Khattak, Evan Adelstein, Sandeep K. Jain, Samir Saba
DOI: 10.5603/CJ.a2015.0055
·
Pubmed: 26412606
·
Cardiol J 2015;22(6):622-629.

open access

Vol 22, No 6 (2015)
Original articles
Published online: 2015-12-30

Abstract

Background: Amiodarone is often prescribed in the management of atrial fibrillation (AF) but is known to cause significant end-organ toxicities. In this study, we examined the impact of amiodarone on all-cause mortality in AF patients with structurally normal hearts.

Methods: We performed a retrospective cohort analysis of all AF patients with structurally normal hearts who were prescribed antiarrhythmic drugs (AAD) for rhythm control of AF at our institution from 2006 to 2013 (n = 2,077). Baseline differences between the amiodarone (AMIO: n = 403) and other AADs (NON-AMIO: n = 1,674) groups were corrected for using propensity score matching.

Results: Amiodarone use as first-line therapy decreased significantly with a higher degree of prescriber specialization in arrhythmia management (31%, 22%, and 9% for primary care physicians, general cardiologists and cardiac electrophysiologists, respectively, p < 0.001). After propensity score matching, baseline comorbidities were balanced between the AMIO and NON-AMIO groups. Over a median follow-up of 28.2 months (range 6.0–100.9 months), amiodarone was associated with increased all-cause (HR 2.41, p = 0.012) and non-cardiac (HR 3.55, p = 0.008) mortality, but not cardiac mortality. AF recurrence and cardiac hospi­talizations were similar between the two study groups.

Conclusions: Amiodarone treatment of AF is associated with increased mortality in patients without structural heart disease and therefore should be avoided or only used as a second-line therapy, when other AF therapies fail. Adherence to guideline recommendations in the management of AF patients impacts clinical outcome.

Abstract

Background: Amiodarone is often prescribed in the management of atrial fibrillation (AF) but is known to cause significant end-organ toxicities. In this study, we examined the impact of amiodarone on all-cause mortality in AF patients with structurally normal hearts.

Methods: We performed a retrospective cohort analysis of all AF patients with structurally normal hearts who were prescribed antiarrhythmic drugs (AAD) for rhythm control of AF at our institution from 2006 to 2013 (n = 2,077). Baseline differences between the amiodarone (AMIO: n = 403) and other AADs (NON-AMIO: n = 1,674) groups were corrected for using propensity score matching.

Results: Amiodarone use as first-line therapy decreased significantly with a higher degree of prescriber specialization in arrhythmia management (31%, 22%, and 9% for primary care physicians, general cardiologists and cardiac electrophysiologists, respectively, p < 0.001). After propensity score matching, baseline comorbidities were balanced between the AMIO and NON-AMIO groups. Over a median follow-up of 28.2 months (range 6.0–100.9 months), amiodarone was associated with increased all-cause (HR 2.41, p = 0.012) and non-cardiac (HR 3.55, p = 0.008) mortality, but not cardiac mortality. AF recurrence and cardiac hospi­talizations were similar between the two study groups.

Conclusions: Amiodarone treatment of AF is associated with increased mortality in patients without structural heart disease and therefore should be avoided or only used as a second-line therapy, when other AF therapies fail. Adherence to guideline recommendations in the management of AF patients impacts clinical outcome.

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Keywords

atrial fibrillation, amiodarone, outcome, mortality

About this article
Title

Mortality risk of long-term amiodarone therapy for atrial fibrillation patients without structural heart disease

Journal

Cardiology Journal

Issue

Vol 22, No 6 (2015)

Pages

622-629

Published online

2015-12-30

DOI

10.5603/CJ.a2015.0055

Pubmed

26412606

Bibliographic record

Cardiol J 2015;22(6):622-629.

Keywords

atrial fibrillation
amiodarone
outcome
mortality

Authors

Dingxin Qin
George Leef
Mian Bilal Alam
Rohit Rattan
Mohamad Bilal Munir
Divyang Patel
Furqan Khattak
Evan Adelstein
Sandeep K. Jain
Samir Saba

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