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Top Things to Know:
Device Therapy and Arrhythmia Management in Left Ventricular Assist Device Recipients

  1. Left ventricular assist devices (LVADs) improve survival and minimize morbidity in patients with end-stage heart failure (HF).
  2. Atrial and ventricular arrhythmias are common in LVAD recipients, likely mediated by the combination of preexisting abnormal myocardial substrate and electrical remodeling after LVAD placement.
  3. There are two indications for placement of a durable LVAD: bridge to transplant and destination therapy in patients not eligible for cardiac transplantation.
  4. Epidemiology, mechanisms and the significance of arrhythmias in LVAD patients is addressed in this statement.
  5. Ventricular arrhythmias (and sudden death) are common after LVAD implantation, observational studies report between in 20%-50% in LVAD recipients.
  6. Less is known about the incidence and impact of atrial arrhythmias in patients with LVADs. Atrial arrhythmias are diagnosed in 21% - 54% of patients before LVAD implantation, with the majority being atrial fibrillation.
  7. Management of cardiovascular implantable electronic devices (CIEDs) in LVAD recipients including implantable cardioverter- defibrillators (ICDs) are addressed in this statement. Cardiac resynchronization therapy (CRT) and related outcomes in these patients are discussed.
  8. Scant observational data (no randomized controlled trials) shows no survival benefit for ICD therapy in patients with continuous-flow (CF) - LVADs.
  9. Catheter ablation in LVAD recipients is reviewed for both atrial and ventricular arrhythmias.
  10. Patients with LVADs are complex and require specialized management. Patients with a CF-LVAD with CIEDs are followed up in the LVAD implantation center by a multidisciplinary team including electrophysiology team and advanced practice nurses experienced in specific CIED and arrhythmia related issues specific to LVAD patients.

Citation

Gopinathannair R, Cornwell WK, Dukes JW, Ellis CR, Hickey KT, Joglar JA, Pagani FD, Roukoz H, Slaughter MS, Patton KK, on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee, Heart Failure and Transplantation Committee of the Council on Clinical Cardiology, and Council on Cardiovascular and Stroke Nursing. Device therapy and arrhythmia management in left ventricular assist device recipients: a scientific statement from the American Heart Association [published online ahead of print April 4, 2019]. Circulation. doi: 10.1161/CIR.0000000000000673.