197: CONTINUATION OF AMIODARONE IN CRITICALLY ILL PATIENTS WITH ATRIAL FIBRILLATION

Abstract

Introduction: Atrial fibrillation (AF) is the most common arrhythmia in critically ill patients in the intensive care (ICU), and leads to longer lengths of stay and an increased mortality. Beta-blockers (BB) are the first-line but are avoided in ICU due to negative inotropic effects in hemodynamically unstable patients. Amiodarone is commonly used to manage AF in ICU due to rate control properties with a minimal decrease in inotropy. Many patients inappropriately continued on amiodarone therapy after transitioning out of ICU, placing patients at increased risk of adverse effects. The purpose of this study was to evaluate the frequency of inappropriate amiodarone continuation after ICU transfer and on discharge. Methods: A retrospective cohort study evaluating patients with AF who were treated with amiodarone infusion between July 1, 2019, and July 1, 2021. Patients were included if they received amiodarone infusion and excluded with a history of ventricular arrhythmias, ICD or pacemaker, and pregnant or lactating mothers. The primary outcome was to assess the proportion of patients discharged on amiodarone. Secondary outcomes included percentage of patients converted to oral once hemodynamically stable, median ICU and hospital length of stay, and percentage of patients converted to BB. Results: A total of 117 patients were evaluated including 79 with chronic AF and 38 with new-onset AF. Amiodarone was continued on discharge in 2 (2.5%) patients in chronic AF group and no patients in new-onset AF group. No patients were converted to oral amiodarone on ICU discharge. Lastly, 28 (35.4%) patients with chronic AF were converted back to BB therapy prior to hospital discharge, while 6 (15.8%) patients were started on BB in new-onset AF group. Conclusions: Although amiodarone was appropriately switched from IV to oral and discontinued in the majority of the patient before ICU or hospital discharge, however, BB therapy was not started or resumed prior to discharge in the majority of patients.