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BACKGROUND While ventricular arrhythmias (VAs) are frequent following left ventricular assist device (LVAD) implantation, the characteristics and prognostic significance of late electrical storm (ES) remain incompletely understood. OBJECTIVE To assess the incidence and clinical impact of late ES in LVAD recipients. METHODS This international, multicenter, retrospective study included 1,151 LVAD recipients implanted between 2006-2019. Late ES was defined as ≥3 sustained VA episodes within 24h occurring beyond 30 days post-implantation. The primary outcome was 5-year all-cause mortality. The secondary endpoint was 5-year cardiac mortality. RESULTS Late ES occurred in 49 patients (4.3%), with median onset at 9.2 months post-implantation. Patients with late ES experienced significantly higher 5-year all-cause mortality (aHR 2.87 1.81-4.54, p<0.01) and cardiac mortality (aHR 3.47 2.14-5.62, p<0.01). Notably, late VA without ES showed no prognostic impact. Multivariable analysis identified four independent predictors of late ES: LVEDD ≥80 mm before LVAD implantation (aHR 2.47 1.29-4.87), non-ischemic cardiomyopathy (aHR 2.20 1.10-4.40), history of VAs (aHR 2.35 1.27-4.32), and ICD before LVAD implantation (aHR 4.80 1.12-20.85). The Late ES-LVAD score, based on these variables, demonstrated good discrimination (C-statistic 0.76) and stratified patients into low- (score 0-1), intermediate- (score 2-3), and high-risk (score 4-5) groups, with corresponding late ES rates of 1.0%, 3.9%, and 7.8%. CONCLUSION Late ES, but not isolated late VAs, is independently associated with substantially worse long-term outcomes in LVAD recipients. The Late ES-LVAD score enables practical risk stratification, facilitating targeted therapeutic interventions in high-risk patients.
Cherbi et al. (Fri,) studied this question.