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Ventricular Arrhythmias in Patients With Left Ventricular Assist Device (LVAD)

  • Arrhythmia (R Kabra, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

Left ventricular assist device (LVAD) implantation is a well-known treatment option for patients with advanced heart failure refractory to medical therapy and is recognized both as bridge to transplant and a destination therapy. The risk of ventricular arrhythmias (VAs) is common after LVAD implantation. We review the pathophysiology and recent advances in the management of VA in LVAD patients.

Recent findings

VAs are most likely to occur in the early post-operative periods after LVAD implantation and a prior history of VA is the most important risk factor. Post-LVAD VAs are usually well tolerated with less morbidity and decreased risk of sudden cardiac death. However, risk of right heart failure in the setting of persistent VAs is being increasingly recognized. The mechanisms of post-LVAD VAs may vary depending on the time from LVAD implantation. Electrical remodeling may play an important role in the immediate post-implant phase. Preexisting myocardial scar and to a lesser extent mechanical irritation from the LVAD cannula are important in the later phases. Most LVAD patients have a previously placed implantable cardioverter-defibrillator (ICD). The benefit of implanting a new ICD in LVAD patients is unknown and should be individualized. For ICD programming, a conservative strategy with higher detection zones and prolonged time to detection is usually recommended aiming to minimize ICD shocks. More aggressive programming is appropriate if the VA results in hemodynamic instability. Antiarrhythmic drugs including amiodarone, mexiletine, and beta blockers are usually the first-line therapy for VAs. Catheter ablation has been shown to be safe and effective in LVAD recipients with recurrent VAs not responsive to antiarrhythmic drugs.

Summary

LVAD-related VA is most frequently reentrant secondary to myocardial scar and usually well tolerated. Management options include antiarrhythmic drugs and catheter ablation.

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Authors and Affiliations

  1. Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA

    Azza Ahmed MD

  2. Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Mustapha Amin MD, Barry A. Boilson MD, Ammar M. Killu MBBS & Malini Madhavan MBBS

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Correspondence to Malini Madhavan MBBS.

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Conflict of Interest

Azza Ahmed, Mustapha Amin, Barry A. Boilson, and Ammar M. Killu each declare no potential conflicts of interest.

Malini Madhavan receives research funding from Bristol-Myers Squibb and Pfizer.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Ahmed, A., Amin, M., Boilson, B.A. et al. Ventricular Arrhythmias in Patients With Left Ventricular Assist Device (LVAD). Curr Treat Options Cardio Med 21, 75 (2019). https://doi.org/10.1007/s11936-019-0783-7

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