Heart transplantation as a rescue strategy for patients with refractory electrical storm

Abstract

BACKGROUND Heart transplantation (HT) can be proposed as a therapeutic strategy for patients with severe refractory electrical storm (ES). Data in the literature are scarce and based on case reports. We aimed at determining the characteristics and survival of patients transplanted for refractory ES. METHODS Patients registered on HT waiting list during the following days after ES and eventually transplanted, from 2010 to 2021, were retrospectively included in 11 French centers. The primary endpoint was in-hospital mortality. RESULTS 45 patients were included (82% men; 55.0 (47.8-59.3) years old; 42.2% and 26.7% non-ischemic dilated or ischemic cardiomyopathies, respectively). Among them, 42 (93.3%) received amiodarone, 29 (64.4%) betablockers; 19 (42.2%) required deep sedation, 22 (48.9%) mechanical circulatory support, and 9 (20.0%) had radiofrequency catheter ablation. Twenty-two patients (62%) were in cardiogenic shock. Inscription on wait list and transplantation occurred 3.0 (1.0-5.0) days and 9.0 (4.0-14.0) days after ES onset, respectively. After transplantation, 20 patients (44.4%) needed immediate hemodynamic support by extracorporeal membrane oxygenation (ECMO). In-hospital mortality rate was 28.9%. Predictors of in-hospital mortality were serum creatinine/urea levels, need for immediate post-operative ECMO support, post-operative complications, and surgical re-interventions. One-year survival was 68.9%. CONCLUSION ES is a rare indication of HT but may be lifesaving in those patients presenting intractable arrhythmias despite usual care. Most patients can be safely discharged from hospital, although post-operative mortality remains substantial in this context of emergency transplantation. Larger studies are warranted to precisely determine those patients at higher risk of in-hospital mortality.

ECMO for drug‐refractory electrical storm without a reversible trigger: a retrospective multicentric observational study

“…In a recent multicenter study from 11 French centers that included 45 patients transplanted for refractory ES, the reported 1 year survival was 69%. 27 In this study, 62% of patients were in cardiogenic shock, and mechanical circulatory support was used as a bridge to cardiac transplantation in 49%. Interestingly, when compared with a previous cohort of drug‐refractory ES treated with VA‐ECMO, the rate of heart transplantation in our study was higher (11% vs. 30%).…”

Enhancing Heart Transplantation: Utilizing Gas-Loaded Nanocarriers to Mitigate Cold/Hypoxia Stress

“…Heart transplantation (HTx) stands as a critical and historical lifeline, offering a vital solution for severe cardiac conditions in patients facing refractory heart failure [ 1 , 2 ]. Challenges, including the narrow window for optimal organ viability during transportation and the heart’s vulnerability to hypoxia/reoxygenation (H/R), have impeded the full success of HTx.…”