Intra-Operative Amiodarone-Releasing Hydrogel to Prevent Post Lung Transplant Atrial Fibrillation: A Pilot Clinical Trial

Abstract

The purpose of this study was to evaluate the effectiveness of topical amiodarone applied to the atria and pulmonary veins at the time of lung transplantation (LTx) in decreasing postoperative atrial fibrillation (POAF). Twenty patients undergoing LTx at a single institution were enrolled in this prospective pilot study and compared to 40 historical controls. An Amiodarone-containing hydrogel was created using CoSeal Surgical Sealant (Baxter Healthcare) and Amiodarone, which was applied to the pulmonary vein anastomoses and atria at time of LTx in the study group. The primary endpoint was development of POAF. Data for the control group was obtained by retrospective chart review. The demographic and clinical information for both groups is demonstrated in Table 1. In the study group, 6 patients (30%) developed POAF (Figure 1), 2 (10%) of which lasted less than 24 hours in duration. In the control group, 18 (52.9%) patients developed POAF, 9 (26.5%) of which lasted less than 24 hours in duration. Three patients in the study group and 4 control patients required cardioversion. In the study group, 20% of patients were discharged home on an anti-arrhythmic medication compared to 47.1% in the control group. There were no adverse outcomes related to the application of Amiodarone Hydrogel. In this small pilot study, the intra-operative application of Amiodarone-containing hydrogel to the pulmonary vein anastomoses and atria appeared to decrease the rates of POAF when compared to historical controls from the same institution.