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

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.