Author + information
- Received December 15, 2016
- Revision received January 19, 2017
- Accepted January 23, 2017
- Published online April 3, 2017.
- Pasquale Santangeli, MD, PhD,
- J. Eduardo Rame, MD,
- Edo Y. Birati, MD and
- Francis E. Marchlinski, MD∗ ()
- ↵∗Address for correspondence:
Dr. Francis E. Marchlinski, Hospital of the University of Pennsylvania, 9 Founders Pavilion–Cardiology, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
Advanced heart failure (A-HF) is characterized by progressive symptoms of heart failure despite optimal therapy. In patients with A-HF, ventricular arrhythmias (VAs) are common. Clinical studies evaluating different therapies to prevent VAs had very limited representation of patients with A-HF. Among antiarrhythmic drugs, only amiodarone reduces VAs, although its use may be associated with increased mortality. Catheter ablation with substrate modification is effective to achieve VA suppression in patients with A-HF, including those with left ventricular assist devices. In high-risk cases, temporary mechanical hemodynamic support tailored to the individual patient on the basis of presentation and hemodynamic conditions may be beneficial. Advanced therapies for pump failure or refractory VAs, including heart transplantation and durable mechanical circulatory support, may be required in high-risk patients who are reasonable candidates for these surgical therapies. In this review, the authors discuss important management considerations in patients with VAs and A-HF.
This work was supported by the Koegel Family EP Research Fund and the Mark Marchlinski EP Research and Education Fund. Dr. Santangeli has received consultant honoraria from Abiomed, St. Jude Medical, Boston Scientific, and Biosense Webster. Dr. Rame has received funding from Thoratec/St. Jude Medical and HeartWare. Dr. Birati has been a consultant for Luitpold Pharmaceuticals; and has received fellowship and research support from HeartWare. Dr. Marchlinski has received consultant and speaking honoraria from Biosense Webster and St. Jude Medical.
- Received December 15, 2016.
- Revision received January 19, 2017.
- Accepted January 23, 2017.
- 2017 American College of Cardiology Foundation
- Central Illustration
- Mechanisms: Pump Failure as a Substrate for VAs
- Mechanisms: VAs as a Basis of Disease Progression in HF
- Clinical Management: Antiarrhythmic Drug Therapy
- Catheter Ablation
- Role of Autonomic Modulation to Manage Recurrent VAs
- Role of Heart Transplantation and Durable MCS
- Special Populations