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Article Dans Une Revue European Heart Journal: Acute Cardiovascular Care Année : 2023

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

Francis Bessière
  • Fonction : Auteur
Matteo Pozzi
Fabrice Extramiana
Zohra Brouk
  • Fonction : Auteur
Charles Guenancia
  • Fonction : Auteur
Audrey Sagnard
  • Fonction : Auteur
Sandro Ninni
Céline Goemine
  • Fonction : Auteur
Pascal Defaye
Aude Boignard
  • Fonction : Auteur
Baptiste Maille
Vlad Gariboldi
  • Fonction : Auteur
Pierre Baudinaud
  • Fonction : Auteur
Anne-Céline Martin
  • Fonction : Auteur
Laure Champ-Rigot
  • Fonction : Auteur
Katrien Blanchart
  • Fonction : Auteur
Jean-Marc Sellal
  • Fonction : Auteur
Christian de Chillou
Katia Dyrda
  • Fonction : Auteur
Laurence Jesel-Morel
  • Fonction : Auteur
Michel Kindo
Corentin Chaumont
Frédéric Anselme
Clément Delmas
  • Fonction : Auteur
Philippe Maury

Résumé

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.
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Dates et versions

hal-04164965 , version 1 (18-07-2023)

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Raphael Martins, Mathilde Hamel-Bougault, Francis Bessière, Matteo Pozzi, Fabrice Extramiana, et al.. Heart transplantation as a rescue strategy for patients with refractory electrical storm. European Heart Journal: Acute Cardiovascular Care, 2023, ⟨10.1093/ehjacc/zuad063⟩. ⟨hal-04164965⟩
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