JACC Clin Electrophysiol. 2026 Feb 26:S2405-500X(26)00125-8. doi: 10.1016/j.jacep.2026.01.050. Online ahead of print.
ABSTRACT
BACKGROUND: Although ventricular arrhythmias (VAs) are common after left ventricular assist device (LVAD) implantation, the features of early electrical storm (ES) remain poorly characterized.
OBJECTIVE: This study aimed to evaluate the incidence and clinical impact of early ES in LVAD recipients.
METHODS: This international, multicenter, retrospective study included 1,309 recipients of LVADs implanted between 2006 and 2019. Early ES was defined as ≥3 sustained VA episodes within 24 hours during the first 30 days’ postimplantation. The primary outcome was 3-month all-cause mortality. Secondary endpoints included 3-month cardiac mortality and early (≤30 days) right ventricular (RV) failure.
RESULTS: Early ES occurred in 56 patients (4.3%), with a median onset at 5 days’ postimplantation. Patients with early ES experienced higher 3-month all-cause mortality (adjusted HR [aHR]: 3.09; 95% CI: 1.91-5.01; P < 0.01) and increased early RV failure (aHR: 2.05; 95% CI: 1.10-3.92; P = 0.03). Notably, early VA without ES showed no prognostic impact. Multivariable analysis identified 4 independent predictors of early ES: pre-LVAD RV S’ wave ≤9.5 cm/s (aHR: 2.25; 95% CI: 1.23-4.14), heart failure duration of ≥5 years (aHR: 2.41; 95% CI: 1.10-5.28), history of VAs (aHR: 4.43; 95% CI: 2.21-8.87), and prior mechanical circulatory support (aHR: 6.40; 95% CI: 2.12-19.33). The EarlyES-LVAD score, based on these variables, showed good discrimination (C-statistic 0.75) and stratified patients into low-risk (score 0-1), intermediate-risk (score 2-3), and high-risk (score 4-6) groups, with corresponding early ES rates of 1.1%, 3.9%, and 12.4%.
CONCLUSIONS: Early ES, but not isolated early VAs, is associated with substantially worse outcomes in LVAD recipients. The EarlyES-LVAD score enables practical risk stratification, facilitating targeted therapeutic interventions in high-risk patients.
PMID:41823945 | DOI:10.1016/j.jacep.2026.01.050
