Short- to mid-term outcomes of refractory electrical storm patients listed for urgent heart transplantation

TL;DR

This study examines the outcomes of patients with refractory electrical storms who are listed for urgent heart transplants, finding high in-hospital mortality and the importance of optimizing transplant selection.

Contribution

The study provides new insights into the outcomes of urgent heart transplant candidates with refractory electrical storms.

Findings

In-hospital mortality was 28.9% for transplanted and 35.0% for non-transplanted patients, with no significant difference.

About 52.9% of patients underwent heart transplantation during their initial hospitalization.

Approximately 16.5% of non-transplanted patients eventually received a transplant within one year.

Abstract

Heart transplantation (HTx) has been suggested for refractory electrical storm (ES). Data regarding the outcomes of these patients are scarce.

To compare the prognosis of refractory ES patients listed for urgent HTx, with and without transplantation.

Patients registered on urgent HTx waiting list for refractory ES were retrospectively included in 13 French centers between 2010–2022. The primary endpoint was in-hospital all-cause mortality.

Eighty-five patients were included (85.9% men; 56.0 [48.0–61.0] years old; 55.1% with dilated cardiomyopathy), among whom 45 (52.9%) ultimately underwent HTx during index hospitalization. In the overall cohort, 89.3% of patients received amiodarone, 64.3% beta-blockers, 45.9% required deep sedation, 5.9% underwent stellate ganglion block, and 41.2% received mechanical circulatory support. Catheter ablation was less frequently performed in the transplanted group (20.0% vs 57.5%, p < 0.01). No difference was found for in-hospital mortality between transplanted and non-transplanted patients (28.9% vs 35.0%, HR 0.72 [0.34–1.53], p=0.0.39). After 1-year follow-up, 14 patients (16.5%) of the non-transplanted group eventually underwent HTx, with 4 of them dying subsequently. Five patients (5.9%) were removed from HTx waiting list due to functional improvement. Conversely, 14 transplanted patients (16.5%) died.

Refractory ES carries a high in-hospital mortality rate, affecting one-third of patients. Overall, 69.4% of patients listed for urgent HTx underwent transplantation, including 52.9% during index hospitalization and 16.5% within the year post-discharge, highlighting the need to optimize selection criteria and implement a comprehensive treatment that sometimes allows overcoming the acute phase, enabling HTx under more stable conditions.

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