Management of Ventricular Arrhythmias in Patients with Left Ventricular Assist Devices: Pathophysiology, Risk Stratification, and Ablation Strategies

Giuseppe Sgarito; Francesco Campo; Sergio Sciacca; Michele Pilato; Manlio Cipriani; Sergio Conti

doi:10.3390/jcm14186604

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Management of Ventricular Arrhythmias in Patients with Left Ventricular Assist Devices: Pathophysiology, Risk Stratification, and Ablation Strategies

Journal article

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Peer reviewed

Management of Ventricular Arrhythmias in Patients with Left Ventricular Assist Devices: Pathophysiology, Risk Stratification, and Ablation Strategies

Giuseppe Sgarito, Francesco Campo, Sergio Sciacca, Michele Pilato, Manlio Cipriani and Sergio Conti

Journal of clinical medicine, Vol.14(18), 6604

09/19/2025

DOI: 10.3390/jcm14186604

PMCID: PMC12470985

PMID: 41010807

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Abstract

Ventricular arrhythmias (VAs) are common and clinically important complications in patients supported by left ventricular assist devices (LVADs), occurring in up to 50% of cases within the first year after implantation. Despite the hemodynamic support provided by LVADs, VAs are linked to increased morbidity and mortality, primarily through recurrent implantable cardioverter defibrillator (ICD) shocks and right ventricular failure. The underlying mechanisms of VAs in this population are multifactorial, involving structural myocardial remodeling, device-related factors, and pre-existing arrhythmic substrates. Catheter ablation has become a valuable treatment option when antiarrhythmic drug therapy and device reprogramming are inadequate, though procedural timing (pre-, intra-, or post-implantation) and approaches remain under discussion. Epicardial access during LVAD surgery may provide advantages for selected patients, while ablation after implantation poses technical challenges due to altered anatomy and electromagnetic interference. This review offers a comprehensive overview of the epidemiology, pathophysiology, risk stratification, and management of VAs in LVAD recipients, emphasizing technical considerations, procedural safety, and clinical outcomes of catheter ablation. A multidisciplinary approach remains essential in guiding personalized treatment and optimizing outcomes for this complex population. Undergoing studies will provide more insight into optimal management of arrhythmias, particularly regarding the optimal timing of catheter ablation. The impact of new technologies such as non-invasive mapping alongside pre-procedural imaging needs also to be further evaluated.

Heart Failure

Electrical Storm

Catheter Ablation

Ventricular Arrhythmias

Left Ventricular Assist Device (LVAD)

Details

Title: Subtitle: Management of Ventricular Arrhythmias in Patients with Left Ventricular Assist Devices: Pathophysiology, Risk Stratification, and Ablation Strategies
Creators: Giuseppe Sgarito - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
Francesco Campo - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
Sergio Sciacca - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
Michele Pilato - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
Manlio Cipriani - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
Sergio Conti - University of Iowa Health Care
Resource Type: Journal article
Publication Details: Journal of clinical medicine, Vol.14(18), 6604
DOI: 10.3390/jcm14186604
PMID: 41010807
PMCID: PMC12470985
NLM abbreviation: J Clin Med
ISSN: 2077-0383
eISSN: 2077-0383
Publisher: MDPI
Language: English
Date published: 09/19/2025
Academic Unit: Internal Medicine
Record Identifier: 9984964810902771

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