PMID- 31883773
OWN - NLM
STAT- MEDLINE
DCOM- 20200916
LR  - 20200916
IS  - 1555-7162 (Electronic)
IS  - 0002-9343 (Linking)
VI  - 133
IP  - 7
DP  - 2020 Jul
TI  - Safety of Outpatient Milrinone Infusion in End-Stage Heart Failure: ICD-Level 
      Data on Atrial Fibrillation and Ventricular Tachyarrhythmias.
PG  - 857-864
LID - S0002-9343(19)31104-0 [pii]
LID - 10.1016/j.amjmed.2019.11.023 [doi]
AB  - BACKGROUND: Milrinone infusion is one of a few select "non-device" therapies for 
      patients with New York Heart Association (NYHA) class IV, stage D heart failure, 
      which has been associated with an increase in ventricular tachyarrhythmia and 
      atrial fibrillation. Milrinone improves hemodynamics and provides symptomatic 
      relief. Many patients with end-stage heart failure die from cardiac pump failure, 
      and the impact of ventricular tachyarrhythmia and atrial fibrillation on their 
      mortality is unclear. METHODS: This is a retrospective study of 98 consecutive 
      patients receiving outpatient milrinone in a single center from 2008 to 2016. The 
      primary endpoint of the study was overall survival on milrinone. Secondary 
      endpoints were incidence of post-milrinone implantable cardioverter defibrillator 
      (ICD) shocks and development of ventricular tachyarrhythmia or atrial 
      fibrillation. RESULTS: Median survival was 581 +/- 96 days with no difference 
      between those with prior ventricular tachyarrhythmia and those without at 1 month 
      (92% vs 97%, P = 0.34), 6 months (67% vs 73%, P = 0.75), and 12 months (67% vs 
      61%, P = 0.88). Seven out of 12 (58%) patients with prior ventricular 
      tachyarrhythmia had ICD shocks, as compared to 5 out of 78 (6.4%) (P <0.001). 
      Thirty-five patients had atrial fibrillation prior to starting milrinone, which 
      decreased to 72% (P <0.05) by the third follow-up time period (7-9 months). 
      Amiodarone use was protective against new onset atrial fibrillation. CONCLUSIONS: 
      Patients with stage D heart failure with a history of ventricular tachyarrhythmia 
      have similar survival on outpatient milrinone compared to those without. However, 
      those with prior ventricular tachyarrhythmia received more ICD shocks for more 
      ventricular tachyarrhythmias. Milrinone remains a viable therapy for patients 
      with stage D heart failure with limited therapeutic options.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Harhash, Ahmed A
AU  - Harhash AA
AD  - Morristown Medical Center, Morristown, NJ; University of Arizona Sarver Heart 
      Center, Ariz. Electronic address: ahmedhrhsh@gmail.com.
FAU - Cassuto, James
AU  - Cassuto J
AD  - Morristown Medical Center, Morristown, NJ.
FAU - Hussein, Ahmed
AU  - Hussein A
AD  - Morristown Medical Center, Morristown, NJ.
FAU - Achu, Emmanuel
AU  - Achu E
AD  - Rutgers University, New Jersey Medical School, NJ.
FAU - Zucker, Mark J
AU  - Zucker MJ
AD  - Rutgers University, New Jersey Medical School, NJ.
FAU - Goldschmidt, Marc
AU  - Goldschmidt M
AD  - Morristown Medical Center, Morristown, NJ.
FAU - Alpert, Joseph S
AU  - Alpert JS
AD  - Professor of Medicine, Department of Medicine, University of Arizona, Tucson; 
      Editor in Chief, The American Journal of Medicine.
FAU - Baran, David A
AU  - Baran DA
AD  - Sentara Heart Hospital, Norfolk, Va.
LA  - eng
PT  - Journal Article
DEP - 20191227
PL  - United States
TA  - Am J Med
JT  - The American journal of medicine
JID - 0267200
RN  - 0 (Cardiotonic Agents)
RN  - JU9YAX04C7 (Milrinone)
SB  - IM
MH  - Aged
MH  - Atrial Fibrillation/*complications/physiopathology/therapy
MH  - Cardiotonic Agents/administration & dosage
MH  - *Defibrillators, Implantable
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Heart Failure/etiology/mortality/*therapy
MH  - Humans
MH  - Infusions, Intravenous
MH  - Male
MH  - Milrinone/*administration & dosage
MH  - Retrospective Studies
MH  - Survival Rate/trends
MH  - Tachycardia, Ventricular/*complications/physiopathology/therapy
OTO - NOTNLM
OT  - Atrial fibrillation
OT  - End-Stage heart failure
OT  - Intravenous milrinone
OT  - Ventricular tachyarrhythmia
EDAT- 2019/12/31 06:00
MHDA- 2020/09/17 06:00
CRDT- 2019/12/30 06:00
PHST- 2019/11/13 00:00 [received]
PHST- 2019/11/22 00:00 [revised]
PHST- 2019/11/25 00:00 [accepted]
PHST- 2019/12/31 06:00 [pubmed]
PHST- 2020/09/17 06:00 [medline]
PHST- 2019/12/30 06:00 [entrez]
AID - S0002-9343(19)31104-0 [pii]
AID - 10.1016/j.amjmed.2019.11.023 [doi]
PST - ppublish
SO  - Am J Med. 2020 Jul;133(7):857-864. doi: 10.1016/j.amjmed.2019.11.023. Epub 2019 
      Dec 27.