Ventricular arrhythmias in patients with heart failure secondary to reduced ejection fraction

PURPOSE OF REVIEW: To review the management of ventricular arrhythmias in patients with heart failure secondary to reduced ejection fraction (HFrEF). RECENT FINDINGS: Recurrent ventricular arrhythmias and automatic implantable cardioverter defibrillator (AICD) shocks are responsible for significant mortality and morbidity in patients with HFrEF. Antiarrhythmic drugs and catheter ablation are the main treatment options. Frequent premature ventricular contractions (PVCs; >10,000-20,000/24-h period) are being recognized as a cause of cardiomyopathy and suboptimal response to cardiac resynchronization therapy (CRT). Patients with ventricular assist devices (VADs) have frequent ventricular tachyarrhythmias resulting in increased morbidity and mortality. Such patients may need continuation of active ICD therapy and adjunctive catheter ablation. SUMMARY: There is a pressing need to develop new antiarrhythmic drugs to treat patients with recurrent AICD shocks. The effectiveness of catheter ablation as first-line therapy for preventing ventricular arrhythmias and recurrent AICD shocks needs to be directly compared with amiodarone. Ventricular tachyarrhythmias are common in CRT patients and patients with VADs. Frequent PVCs may result in a reversible form of HFrEF.