*Purpose: Previous studies have demonstrated a correlation between pre-transplant amiodarone use and post-operative bradycardia, primary graft dysfunction, and mortality in heart transplant (HT) recipients; this study aimed to report the effects of cumulative pre-HT amiodarone dosing on post-HT outcomes and it is the first study of its kind to do so.

*Methods: Adult HT recipients from 1/1/2008 to 6/1/2018 who received amiodarone within 90 days prior to HT were retrospectively evaluated. The association of amiodarone dosing with the following outcomes was assessed: survival, ventilator days, length of stay, and the incidence of significant bradycardia requiring beta-agonist use or permanent pacemaker implantation.

*Results: 108 patients were analyzed. Multivariate regression identified that greater cumulative pre-HT amiodarone doses are associated with an increased incidence of bradycardia requiring the use of terbutaline or permanent pacemaker (P=0.003), as well as a significantly greater incidence of 1-year mortality (P=0.048), days on the ventilator (P=0.002), and index HT hospital length of stay. Higher doses were also associated with more refractory hypotension (P=0.026) and required a longer duration of inotropes after HT (P=0.025).

*Conclusions: Higher doses of amiodarone prior to HT are associated with worse outcomes, including higher mortality, length of stay, days on the ventilator, and significant bradycardia. Efforts should be made to minimize cumulative amiodarone dose in the three months preceding HT, particularly in patients with non-life-threatening indications such as supraventricular arrhythmias.

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