Ventricular Arrhythmias After Left Ventricular Assist Device

Abstract

Despite advances in medical therapy, heart failure remains one of the major causes of hospitalizations and deaths in the United States. Approximately 5.7 million patients have heart failure, and it is the direct cause of death for 57 000 individuals annually.1 Although the combination of optimal medical therapy, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy has reduced mortality rates, an estimated 50% of patients with heart failure still die within 5 years of diagnosis.1 Heart transplant is often the best therapeutic option for patients with end-stage heart failure; however, there has been a stable plateau of ≈2200 transplants/y in the United States due largely to limitations in organ availability.1 For patients who are facing unfavorably long wait times for heart transplantation, left ventricular assist devices (LVAD) have become a lifesaving option as a bridge to transplant. Currently, one quarter to one third of all heart transplant recipients are bridged with mechanical circulatory support before transplantation.2 Much of this support is in the form of permanent LVADs—surgically implanted mechanical assist devices that unload the left ventricle and can function in ambulatory patients (Figure 1). The use of permanent LVADs as destination therapy has increased dramatically, with evidence that they benefit patients with end-stage heart failure, despite noncandidacy for heart transplantation. Since the seminal Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure destination therapy trial in 2001, ≈1578 destination therapy LVADs have been implanted, with implant rates increasing rapidly.3,4 Figure 1. Examples of implantable cardioverter-defibrillators (ICDs) with 2 different types of left ventricular assist devices (LVADs). Posterior-anterior chest x-ray projections of biventricular ICDs in the presence of HVAD ( A ) and Heartmate II ( B ) models of LVAD. Development of LVADs dates to 1969 when the world’s first total artificial heart was implanted by Dr …