Abstract 4371337: Impact of Antiarrhythmic Use on Primary Graft Dysfunction in Orthotopic Heart Transplant Patients: A Single Center Retrospective Cohort Study

Abstract

Introduction: Orthotopic heart transplantation is the definitive treatment for end stage heart failure leading to improved quality of life. Primary Graft Dysfunction (PGD) is one of the most feared complications post orthoptic transplantation and is the leading cause of mortality in first 30 days. Per the International Society of Heart and Lung Transplant (ISHLT) Consensus, the diagnosis of PGD is made within 24 hours after completion of cardiac transplant. ISHLT classifies PGD as Left ventricle: mild, moderate and severe PGD and Right Ventricle PGD. Anti-arrhythmic medications such as amiodarone have been noted to increase the risk of PGD and thus normally discontinued when patients reach a UNOS level 1-3 status. However, other antiarrhythmics which are continued up until the day of transplant may be associated with PGD. Objective: This study aims to investigate the association between antiarrhythmics and Primary graft dysfunction. Methods: A retrospective cohort of Orthotopic Heart Transplants from July 2022 through to March 2024 at the Samsky Advanced Heart Failure Center, Piedmont Heart Institute were analyzed. Participants were classified by antiarrythmic drug use. PGD was analyzed as a categorical variable. Univariate and multivariate logistic regression were performed to assess the association between anti-arrhythmic drugs and PGD, adjusting for potential confounders including age, gender, and race. Results: Among the 133 participants, the mean age was 57.4 years, 74.4% were males, 51.13% of the population were African-American, and 42.86% White/Caucasian. Out of the patients who had OHT and antiarrhythmics up till the day of transplant; 11 were on mexiletine; 9 were on sotalol; 7 were on digoxin; 2 were on dofetilide; and 1 on quinidine, lidocaine, and disopyramide respectively. 14 PGD cases were noted. 8 of them were left PGD and 6 right PGD. 4 out of 8 L-PGD, were severe. 4 ( 1 each for mild, moderate, severe L-PGD and R-PGD respectively) out of the 14 patients who had PGD were on sotalol. Sotalol was significantly associated with PGD [OR 5.14, P=0.035, 95% CI 1.13-23.43] and severity of PGD [ OR 6.8, P=0.075 95%CI 0.87-16.37. ] After adjusting for confounders, the association remained statistically significant [OR 5.49, P=0.031, 95%CI 1.17-25.73]. Conclusion: Patients on sotalol had 5.49 times more odds off having PGD post-transplant and this was statistically significant regardless of age, gender and race.