PSHP 2026 Residency Conference

Purpose: To evaluate the real-world patterns and outcomes of amiodarone therapy in lung transplant recipients who develop new-onset post-operative atrial arrhythmias (POAA) after surgery. 
Methods: This is a retrospective, single-center chart review of 46 lung transplant recipients at Temple University Hospital from September 1, 2021 to August 31, 2025, who were discharged on amiodarone due to new-onset atrial arrhythmia. The cumulative amiodarone dose received and the total number of days of amiodarone use were calculated using information from the electronic medical record. Secondary endpoints included incidence of amiodarone induced pulmonary toxicity; discontinuation of amiodarone due to pulmonary toxicity, thyroid dysfunction, or hepatotoxicity; incidence of readmissions due to arrhythmias; and risk factors associated with atrial arrhythmias after lung transplant. Data collection included baseline characteristics, rate control therapy, anticoagulation, and information regarding electrophysiology (EP) follow-up. Descriptive statistics were utilized to analyze the data. 
Results: Amiodarone therapy was used for longer than six months in 10/46 patients. The average cumulative amiodarone dose was 29,228 mg, 95% CI [26,069, 32,387] and average duration of amiodarone was 100 days, 95% CI [86, 115]. There were no reports of amiodarone-induced pulmonary toxicity. Amiodarone was discontinued for one patient that was found to have elevated liver enzymes attributed to amiodarone. Two patients had elevated TSH levels attributed to amiodarone, but the medication was not discontinued. Twenty-five patients followed up with EP at an average of 88 days after discharge. Risk factors for the patient population evaluated included 88% over the age of 60 years, 78% male, and 56% with a history of coronary artery disease (CAD). 
Conclusion: Lung transplant recipients face increased risk of POAA. Amiodarone was generally well tolerated in this cohort, with short treatment durations and no cases of pulmonary toxicity. Limited adverse effects occurred, including one discontinuation for hepatotoxicity and two cases of thyroid dysfunction. Consideration should be given to defining optimal treatment duration, adverse effect monitoring, EP follow-up, and assessment of risk factors.