*Purpose: Atrial arrhythmias occur in 16-46% of patients after lung transplant, and most of these are atrial fibrillation or flutter. Standard therapy is described as rate control with correction of electrolyte imbalances and optimization of fluid status. Amiodarone is generally considered first line therapy for atrial arrhythmias but is often avoided in lung transplant patients because of its association with pulmonary fibrosis. This paper describes the outcomes for frequent use of amiodarone in a cohort of lung transplant recipients.

*Methods: This study reviews the medical records of 255 lung transplant patients at a single center from 2014 to 2018. Atrial arrhythmias were managed initially with rate control, but amiodarone was administered to the majority if there was not immediate resolution of the dysrhythmia. Standard dosing was administered. Outcomes included resolution of the dysrhythmia within 48 hours of onset, time on the ventilator, recurrence of the dysrhythmia during hospitalization, length of hospital stay, and patient survival.

*Results: There were 102 patients with post lung transplant atrial arrhythmia (40%), and 79% of these patients were treated with intravenous amiodarone. Patients at risk for post-transplant atrial arrhythmia included those patients who were older, male, and had a higher body mass index (p<0.05 for all). Also at risk were patients with previously noted PACs and/or PVCs on a previous EKG taken within 1 year of the operation (p<0.01). Those with elevated right ventricular systolic pressures were at lower risk of arrhythmia (p<0.001). Patient survival did not differ for patients receiving amiodarone therapy (compared to non-amiodarone atrial arrhythmia patients). These groups also did not differ in ventilator time, length of stay, and long-term survival.

*Conclusions: In this cohort, intravenous amiodarone therapy in lung transplant patients with new onset atrial arrhythmias did not result in any identifiable pathology. Clinical outcomes for these two study groups were similar. These results suggest that amiodarone can be safely used in this population.

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