Electrical Storm in Patients with Left Ventricular Assist Devices: Risk Factors, Incidence, and Impact on Survival.

Abstract Background Ventricular arrhythmias (VAs) and electrical storm (ES) are recognized complications following left ventricular assist device (LVAD) implantation, although their association with long term outcomes remains poorly understood. Objective To describe the clinical impact of ES in a population of patients undergoing LVAD implantation at a quaternary care center in the United States. Methods This was an observational retrospective study of patients undergoing LVAD implantation from 2009 to 2020 at Duke University Hospital. The incidence of ES (≥3 sustained VA episodes over a 24-hour period without an identifiable reversible cause) was determined from patient records. Risk factors for ES were identified using multivariable Cox proportional hazards modeling. Results Among 730 patients undergoing LVAD implant, 78 (10.7%) developed ES at a median of 269 (interquartile range [IQR] 7-766) days following surgery. Twenty-seven patients (34.6%) developed ES within 30 days while 51 (65.4%) presented with ES a median 639 (IQR 281-1,017) days after implant. Following ES, 41% of patients died within one-year. Patients developing ES were more likely to have a history of VAs, VT ablation, antiarrhythmic drug use, and perioperative mechanical circulatory support around the time of LVAD implant compared with patients without ES. Conclusions Electrical storm occurs in 1 in 10 patients after LVAD and is associated with higher mortality. Risk factors for ES include a history of VAs, VT ablation, antiarrhythmic drug use, and perioperative mechanical circulatory support. Optimal management of ES surrounding LVAD implant, including escalation of medical therapy, catheter ablation, or adjunctive sympatholytic therapies remains uncertain.