Catheter Ablation -> Ventricular Arrhythmias -> Clinical Trials / Outcomes D-PO05 - Poster Session V (ID 39) Poster

D-PO05-192 - Outcomes Of A Painesd Score-guided Stepwise Multidisciplinary Management Approach For High-risk Patients With Biventricular Heart Failure And Electrical Storm (ID 1303)


Background: Patients with a PAINESD score>17, biventricular heart failure (B-HF) and ventricular tachycardia (VT) electrical storm (ES) have a poor prognosis, with prior studies reporting up to 76% mortality at 1 month.
Objective: We evaluated the outcomes associated with a stepwise multidisciplinary management approach for patients with high PAINESD scores and B-HF presenting with ES.
Methods: Since 2016 consecutive patients with a PAINESD score >17, B-HF and ES were managed by a multidisciplinary team including HF specialists, cardiac surgeons and electrophysiologists. Patients were admitted for hemodynamic optimization, inotropic support and to assess candidacy for advanced HF therapies (Step 1). Following assessment of the vascular access sites with imaging, mechanical circulatory support with VA-ECMO (femoral vein to femoral artery or axillary artery in case of peripheral arterial disease) was initiated electively (Step 2). Catheter ablation (CA) was performed with the endpoint of VT non-inducibility and elimination of abnormal electrograms when possible (Step 3). In select patients, repeat noninvasive programmed stimulation was performed while still on VA-ECMO support before decannulation.
Results: Nine patients (age 58.7±6.6 years, 56% with NICM) with a PAINESD score >17 (mean 22.5±4.8), B-HF (mean LVEF 21.9±5.5%, moderate/severe RV dysfunction) and ES were included. After HF optimization (Step 1), patients underwent elective implantation of VA-ECMO (8 cases) before the CA procedure or in the immediate post-procedural period as a short-term bridge to LVAD (1 case) (Step 2). Median duration from admission with ES to CA was 5 days (1-19 days) and median duration of VA-ECMO support was 2 days (1-5 days). The procedure was acutely successful with suppression of ES and no in-hospital recurrence of VT in all patients (Step 3). VA-ECMO was successfully weaned in 8/9 cases. Over a mean follow-up duration of 5 months (range 1-14 months), 1 (11%) patient died, 1 (11%) underwent LVAD implant, and 2 (22%) had recurrent VT.
Conclusion: A PAINESD score-guided stepwise multidisciplinary management approach in patients with severe B-HF and ES is associated with a significant reduction in expected mortality.