Management of Ventricular Arrhythmias in Patients With Advanced Heart Failure

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.