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Impact of early ventricular arrhythmia recurrence after electrical storm treatment on mortality and heart failure events

https://doi.org/10.1007/s00392-024-02526-y

Thomas Fink (Bad Oeynhausen)1, M. Mörsdorf (Bad Oeynhausen)1, V. Sciacca (Bad Oeynhausen)1, A. Parlato (Bad Oeynhausen)1, D. Guckel (Bad Oeynhausen)1, M. Khalaph (Bad Oeynhausen)1, M. Braun (Bad Oeynhausen)1, M. El Hamriti (Bad Oeynhausen)1, C.-F. Niehaus (Osnabrück)2, G. Imnadze (Bad Oeynhausen)1, M. Didenko (Bad Oeynhausen)1, C. Sohns (Bad Oeynhausen)1, P. Sommer (Bad Oeynhausen)1

1Herz- und Diabeteszentrum NRW Klinik für Elektrophysiologie/ Rhythmologie Bad Oeynhausen, Deutschland; 2Marienhospital Osnabrück Klinik für Innere Medizin / Kardiologie Osnabrück, Deutschland

 

Background: Electrical storm (ES) is caused by frequent or incessant ventricular arrhythmia (VA) and most commonly occurs in individuals with structural heart diseases. ES is associated with high intrahospital mortality and therapy deliveries in patients with implantable cardioverter defibrillators (ICD).

Objective: The purpose of this single-center study was to analyze the impact of early ventricular arrhythmia recurrence after electrical storm on mortality and heart failure.

Methods: Data from patients who were admitted for treatment of ES from 2016 to 2021 in a high-volume electrophysiologic center were retrospectively analyzed. A composite clinical endpoint consisting of left ventricular assist device (LVAD) implantation, heart transplantation (HTX), death and freedom from VA events was investigated. VA events were defined as any sustained VA or adequate ICD therapy. The composite endpoint was analyzed with regards to the occurrence of early VA recurrence within 30 days after ES.

Results: A total of 155 patients (mean age 64±14 years, mean left ventricular systolic ejection fraction 30±11 %, 150 patients with structural heart disease) who were admitted with ES to our VT unit were analyzed. Treatment consisted of catheter ablation in 100 cases and conservative therapy in 55 cases. Median follow-up duration was 671 (interquartile range 368 to 1250) days. Early recurrence during the ES hospital admission occurred in 15 patients (10 with catheter ablation and 5 with conservative management) after a mean of 10±4 days. There was no statistically significant difference in ventricular arrhythmia-free survival after discharge between patients with and without early ventricular arrhythmia recurrence (log rank P=0.169). The primary endpoint occurred significantly more often in patients with early VA recurrence after ES than in patients without (12/15 patients with early VA recurrence, 86/140 patients without early VA recurrence, p=0.022). Time to occurrence of the primary endpoint after ES was significantly longer in patients who did not experience early VA recurrence (log rank P=0.022, Figure 1).

Conclusion:

 

Early arrhythmia-recurrence after initial treatment of ES was associated with impaired event-free survival with regards to LVAD implantation, HTX and death.




Figure 1

Estimated freedom from a composite clinical endpoint (freedom from LVAD/HTX or death) in patients with ES with and without early arrhythmia.

 

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