Primary Graft Dysfunction After Heart Transplantation for Chagas Disease With Refractory Electrical Storm.

BACKGROUND

Electrical storm in Chagas disease represents a life-threatening scenario, particularly in Latin America.

CASE SUMMARY: A 62-year-old man developed recurrent ventricular tachycardia a decade after implantable cardioverter-defibrillator placement for Chagas cardiomyopathy. Despite optimized therapy, arrhythmia control was not achieved, culminating in refractory electrical storm. He underwent heart transplantation. Severe primary graft dysfunction developed intraoperatively. Peripheral venoarterial extracorporeal membrane oxygenation was initiated, unloading with an intra-aortic balloon pump and direct left atrial drainage, achieving successful recovery.

DISCUSSION: Management of refractory electrical storm is complex and may require mechanical circulatory support. Heart transplantation is a therapeutic option. When primary graft dysfunction occurs, venoarterial extracorporeal membrane oxygenation provides effective support, particularly when combined with active unloading.

TAKE-HOME MESSAGES: Heart transplantation should be considered for refractory electrical storm in Chagas disease. Severe primary graft dysfunction is a major complication that could be reversed with structured, physiology-guided support.