Abstract
The successful management of ventricular arrhythmias (VAs) in people with left ventricular assist devices (LVADs) is often complex. The need for and the role of defibrillator therapy is continually evolving in this group. VAs occur frequently and significantly impact the clinical course of patients with LVADs. The management of VAs begins prior to LVAD implantation and typically involves appropriate implantable cardioverter-defibrillator use and programming after the fact. Surgical ablation during LVAD implantation and supplementary catheter ablation performed as needed are attractive options for the management of VAs in this population. The performance of catheter ablation is generally safe and feasible after LVAD implantation with a team approach.
Highlights
Continuous-flow left ventricular (LV) assist devices (LVADs) have revolutionized the care of patients with severe heart failure
The burden of Ventricular arrhythmias (VAs) in left ventricular assist devices (LVADs) patients can reach more than 40% within two years, with a resulting significant impact on the quality of life.[3]
A not uncommon clinical scenario is that a patient with an LVAD presents with sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) with minimal symptoms.[2]
Summary
Continuous-flow left ventricular (LV) assist devices (LVADs) have revolutionized the care of patients with severe heart failure. Their use is expanding, and LVAD destination therapy may represent an alternative to transplantation in some younger patients. More than 22,000 patients have received mechanical circulatory support as of the beginning of 2017.1,2 Ventricular arrhythmias (VAs) are a common comorbidity of LVAD use. The burden of VAs in LVAD patients can reach more than 40% within two years, with a resulting significant impact on the quality of life.[3]. With an LVAD and VAs in the setting of right ventricular (RV) dysfunction and high pulmonary vascular resistance (PVR) are at risk for severe RV deterioration. Other predictors of VAs arising after LVAD implantation include a history of atrial fibrillation.
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