Implication to Prevent Tachyarrhythmia by Amiodarone Therapy During Durable Left Ventricular Assist Device Supports

To the Editor: Graboyes et al.1 demonstrated that prophylactic amiodarone therapy was associated with a reduction in the incidence of postoperative arrhythmias, particularly atrial arrhythmias, without incremental incidence of amiodarone-related adverse events among those receiving durable continuous-flow left ventricular assist devices (CF-LVAD). Several concerns have been raised. The implication to prevent all postoperative tachyarrhythmias following CF-LVAD implantation is uncertain.1 Ventricular arrhythmias was not associated with in-hospital mortality and morbidity in patients receiving CF-LVAD supports in the US nationwide database.2 In another study conducted in Japan, the existence of atrial fibrillation was not associated with the development of hemocompatibility-related adverse events during CF-LVAD supports.3 On the contrary, the frequent low-flow alerts were managed by catheter ablation to treat ventricular tachyarrhythmias in a case report.4 It might be of great interest to investigate tachyarrhythmia-induced hemodynamic deterioration as a primary outcome. The definition of prophylactic treatment is unclear. In the authors’ study, some patients had history of arrhythmias and others received antiarrhythmic agents during CF-LVAD supports.1 The concomitant use of renin-angiotensin-aldosterone system inhibitors, which might also suppress the development of tachyarrhythmias, is unclear. The authors followed liver and thyroid function during amiodarone therapy for the safety analyses but did not investigate the incidence of interstitial pneumonia, which is one of the most fatal drug-related adverse events.1 How was associated biomarkers such as KL-6 and SP-D during amiodarone therapy? Although it did not reach statistical significance, more patients receiving amiodarone trended to encounter death or CF-LVAD exchange. Could the authors clarify the causes of their death?