胺碘酮相关的间质性肺疾病（ILD）是胺碘酮治疗最严重的不良反应。关于胺碘酮相关 ILD 的大多数数据都来自胺碘酮服用剂量高于目前使用剂量的时期。在 1999 年 12 月 1 日至 2021 年 12 月 31 日期间，对发生心房颤动 (AF) 的患者进行了一项全国范围的人口研究。根据年龄、性别、种族和 AF 诊断持续时间，将暴露患者与未暴露于胺碘酮的对照进行 1:1 匹配。最终的患者队列仅包括匹配的配对，其中胺碘酮治疗在整个随访过程中保持一致。使用有向无环图和逆概率处理加权（IPTW）建模。既往患有 ILD 或原发性肺癌 (PLC) 的患者被排除在外。主要结局是任何 ILD 的发生率。次要终点是死亡和 PLC。最终队列包括 6039 名胺碘酮暴露患者，他们与未暴露的对照组相匹配。中位年龄为 73.3 岁，其中 51.6% 为女性。平均随访 4.2 年后，242 名 (2.0%) 患者出现 ILD。 IPTW 后，胺碘酮暴露与 ILD 没有显着相关性 [风险比 (HR)：1.45，95% 置信区间 (CI)：0.97、2.44，P = 0.09]。在随访第 2 年至第 8 年期间，胺碘酮暴露患者发生 ILD 的相对风险略高[最大风险比 (RR)：1.019]。 97 名患者（0.8%）发生原发性肺癌。 IPTW 后，胺碘酮与 PLC 无关（HR：1.18，95% CI：0.76、2.08，P = 0.53）。 2185 名患者（18.1%）发生全因死亡。 IPTW 后，胺碘酮与死亡风险降低相关（HR：0.65，95% CI：0.60、0.72，P < 0.001）。各种敏感性分析的结果是一致的。在当代 AF 人群中，低剂量胺碘酮与 ILD 风险增加的趋势相关 (15%-45%)，但绝对风险的变化在临床上可以忽略不计（最大 1.8） %)，PLC 风险没有增加，全因死亡率风险较低。© 作者 2023。由牛津大学出版社代表欧洲心脏病学会出版。版权所有。如需权限，请发送电子邮件至：journals.permissions@oup.com。

Amiodarone-related interstitial lung disease (ILD) is the most severe adverse effect of amiodarone treatment. Most data on amiodarone-related ILD are derived from periods when amiodarone was given at higher doses than currently used.A nationwide population-based study was conducted among patients with incident atrial fibrillation (AF) between 1 December 1999 and 31 December 31 2021. Amiodarone-exposed patients were matched 1:1 with controls unexposed to amiodarone based on age, sex, ethnicity, and AF diagnosis duration. The final patient cohort included only matched pairs where amiodarone therapy was consistent throughout follow-up. Directed acyclic graphs and inverse probability treatment weighting (IPTW) modelling were used. Patients with either prior ILD or primary lung cancer (PLC) were excluded. The primary outcome was the incidence of any ILD. Secondary endpoints were death and PLC.The final cohort included 6039 amiodarone-exposed patients who were matched with unexposed controls. The median age was 73.3 years, and 51.6% were women. After a mean follow-up of 4.2 years, ILD occurred in 242 (2.0%) patients. After IPTW, amiodarone exposure was not significantly associated with ILD [hazard ratio (HR): 1.45, 95% confidence interval (CI): 0.97, 2.44, P = 0.09]. There was a trivial higher relative risk of ILD among amiodarone-exposed patients between Years 2 and 8 of follow-up [maximal risk ratio (RR): 1.019]. Primary lung cancer occurred in 97 (0.8%) patients. After IPTW, amiodarone was not associated with PLC (HR: 1.18, 95% CI: 0.76, 2.08, P = 0.53). All-cause death occurred in 2185 (18.1%) patients. After IPTW, amiodarone was associated with reduced mortality risk (HR: 0.65, 95% CI: 0.60, 0.72, P < 0.001). The results were consistent across a variety of sensitivity analyses.In a contemporary AF population, low-dose amiodarone was associated with a trend towards increased risk of ILD (15%-45%) but a clinically negligible change in absolute risk (maximum of 1.8%), no increased risk of PLC, and a lower risk of all-cause mortality.© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.