Effect of VT Ablation on Time Between VT Storm and Heart Transplant

Abstract

<h3>Purpose</h3> Ventricular arrhythmia occurs frequently in patients with advanced heart failure. The optimal treatment strategy is not well-characterized. We performed a retrospective study of patients with ventricular tachycardia (VT) storm who underwent heart transplant and compare the outcomes of those who received prior ablation to those who did not. <h3>Methods</h3> VT storm was defined as three or more episodes of sustained VT, with or without external defibrillation or appropriate implantable cardioverter-defibrillator therapy within 24 hours. Patients who underwent heart transplantation at UCSD between 2010 and 2021 (N=411) were screened for history of VT storm (n=34). Patients were then stratified by occurrence of VT ablation prior to transplant. We compared time to transplant and post-transplant survival using Chi square and Mann Whitney U tests. <h3>Results</h3> Of the 34 patients with VT storm, 14 underwent VT ablation and 20 did not. Median age was 63 years old. Patient demographics between the two groups were similar, except prevalence of chronic kidney disease stage ≥3 (70% vs 29%, p = 0.017) was higher in patients without VT ablation. Four patients expired during follow up, with no statistically significant difference between the two groups. Median time from VT storm to transplant was 206.5 days in those who underwent ablation compared to 66.5 days (p =0.046) in those who did not (Table 1). <h3>Conclusion</h3> In a single-center, retrospective study of patients with advanced heart failure and VT storm, VT ablation extended transplant-free survival without affecting mortality. Larger studies are needed to assess the optimal management strategy in this patient population.