Left ventricular assist devices (LVADs) are an increasingly used strategy for the management of patients with advanced heart failure. Although these devices effectively improve survival, atrial and ventricular arrhythmias are common with a prevalence of 20-50% at one year after LVAD implantation. Arrhythmias predispose these patients to additional risk and are associated with considerable morbidity from recurrent implantable cardioverter-defibrillator shocks, progressive failure of the unsupported right ventricle, and herald an increased risk of mortality. Management of patients with arrhythmias and LVAD differs in many aspects from the general population heart failure patients. These include ruling out the reversible causes of arrhythmias that in LVAD patients may include mechanical irritation from the inflow cannula and suction events. For patients with symptomatic arrhythmias refractory to medical treatment, catheter ablation might be relevant. There are specific technical and procedural challenges perceived to be unique to LVAD-related ventricular tachycardia (VT) ablation such as vascular and LV access, signal filtering, catheter manoeuvrability within decompressed chambers, and electroanatomic mapping system interference. In some patients, the arrhythmogenic substrate might not be readily accessible by catheter ablation after LVAD implantation. In this regard, the peri-implantation period offers a unique opportunity to surgically address arrhythmogenic substrate and suppress future VT recurrences. This document aims to address specific aspects of the management of arrhythmias in LVAD patients focusing on anti-arrhythmic drug therapy and ablations.

Armed Forces Hospital Porto Portugal

Cardiac Arrhythmia Department Univ Bordeaux CHU de Bordeaux INSERM CRCTB U 1045 IHU Liryc Bordeaux France

Cardiopulmonary Department San Raffaele Open University of Rome IRCCS San Raffaele Roma Roma Italy

Clinic for Arrhythmology Klinikum Nuernberg Süd University Hospital of the Paracelsus Medical University Nuernberg Germany

Complexo Hospitalario Universitario A Coruña A Coruña Spain

Department of Cardiac Electrophysiology Great Metropolitan Hospital Niguarda Milan Italy

Department of Cardiology and Vascular Medicine University Hospital Frankfurt Goethe University Frankfurt ZIM Med Klinik 3 Kardiologie Angiologie Frankfurt am Main Germany

Department of Cardiology Hospital de Santa Cruz Carnaxide Lisbon Portugal

Department of Cardiology IKEM Vídeňská 1958 9 Prague Czech Republic

Department of Cardiology Rangueil Hospital of Toulouse Toulouse France

Department of Cardiology Rigshospitalet Denmark

Department of Cardiology University Hospital of Rennes Rennes France

Department of Electrophysiology German Heart Center Munich Technical University of Munich Munich Germany

Department of Medical and Surgical Specialties Radiological sciences and Public Health Institute of Cardiology ASST Spedali Civili University of Brescia Brescia Italy

Faculty of Medicine of the University of Porto Portugal

Heart Center Hadassah Medical Center and Hebrew University Jerusalem Israel

Heart Institute at Hospital Universitari Germans Trias i Pujol CIBERCV Badalona Spain

Hôpital cardiologique du Haut Lévêque Cardiology Cardiac Electrophysiology Department Pessac France and IHU Liryc L'Institut des maladies du rythme cardiaque Site Hôpital Xavier Arnozan Pessac France

Institute of Emergency for Cardiovascular Diseases 'C C Iliescu' Bucharest Romania

Internal Medicine Unit for Cancer Patients Department of Translational Medical Sciences Federico 2 University Naples NA Italy

Leiden University Medical Center Leiden The Netherlands

Montefiore Medical Center Albert Einstein College of Medicine Bronx NY USA

School of Cardiovascular and Medical Sciences University of Glasgow Glasgow UK

School of Medicine Balamand University Beirut Lebanon Abu Dhabi UAE

School of Medicine Johns Hopkins University Baltimore MD USA

Sheikh Shakhbout Medical City Abu Dhabi UAE

University of Medicine Carol Davila Bucharest Romania

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