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.

• Keywords
• Atrial fibrillation, Catheter ablation, Heart failure, Left ventricular assist device, Ventricular arrhythmia,
• MeSH
• Anti-Arrhythmia Agents * therapeutic use   MeSH
• Ventricular Function, Left MeSH
• Catheter Ablation * methods   MeSH
• Tachycardia, Ventricular therapy   surgery   physiopathology   MeSH
• Consensus MeSH
• Humans MeSH
• Heart-Assist Devices * MeSH
• Risk Factors MeSH
• Arrhythmias, Cardiac * therapy   physiopathology   diagnosis   MeSH
• Heart Failure * therapy   physiopathology   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Practice Guideline MeSH
• Geographicals
• Europe MeSH
• Names of Substances
• Anti-Arrhythmia Agents * MeSH

Catheter ablation (CA) has become an established treatment strategy for managing recurrent ventricular tachycardias (VTs) in patients with structural heart disease. In recent years, percutaneous mechanical circulatory support (PMCS) devices have been increasingly used intra-operatively to improve the ablation outcome. One indication would be rescue therapy for patients who develop haemodynamic deterioration during the ablation. However, more efforts are focused on identifying subjects who are at high risk of such deterioration and could benefit from the pre-emptive use of the PMCS. The third reason to use PMCS could be the inability to identify diffuse substrate, especially in non-ischaemic cardiomyopathy. This paper reviews available experiences using various types of PMCS in different clinical scenarios. Although PMCS allows mapping during VT, it does not significantly influence acute outcomes and not convincingly long-term outcomes. On the contrary, the complication rate appears to be higher in PMCS cohorts. Our data suggest that even in patients with severe left ventricular dysfunction, the substrate modification can be performed without the need for general anaesthesia and risk of haemodynamic decompensation. In end-stage heart failure associated with the electrical storm, implantation of a left ventricular assist device (or PMCS with a transition to the left ventricular assist device) might be the preferred strategy before CA. In high-risk patients who are not potential candidates for these treatment options, radiotherapy could be considered as a bail-out treatment of recurrent VTs. These approaches should be studied in prospective trials.

• Keywords
• Catheter ablation, Percutaneous mechanical support, Stereotactic arrhythmia radiotherapy, Substrate modification, Ventricular tachycardia,
• MeSH
• Hemodynamics MeSH
• Catheter Ablation * methods   adverse effects   MeSH
• Tachycardia, Ventricular * surgery   physiopathology   MeSH
• Humans MeSH
• Heart-Assist Devices * MeSH
• Risk Factors MeSH
• Heart Failure physiopathology   therapy   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Electrical storm (ES) is a state of electrical instability, manifesting as recurrent ventricular arrhythmias (VAs) over a short period of time (three or more episodes of sustained VA within 24 h, separated by at least 5 min, requiring termination by an intervention). The clinical presentation can vary, but ES is usually a cardiac emergency. Electrical storm mainly affects patients with structural or primary electrical heart disease, often with an implantable cardioverter-defibrillator (ICD). Management of ES requires a multi-faceted approach and the involvement of multi-disciplinary teams, but despite advanced treatment and often invasive procedures, it is associated with high morbidity and mortality. With an ageing population, longer survival of heart failure patients, and an increasing number of patients with ICD, the incidence of ES is expected to increase. This European Heart Rhythm Association clinical consensus statement focuses on pathophysiology, clinical presentation, diagnostic evaluation, and acute and long-term management of patients presenting with ES or clustered VA.

• Keywords
• Arrhythmia, Consensus document, Electrical storm, Sudden cardiac death, Ventricular fibrillation, Ventricular tachycardia,
• MeSH
• Defibrillators, Implantable * MeSH
• Incidence MeSH
• Tachycardia, Ventricular * diagnosis   therapy   complications   MeSH
• Humans MeSH
• Risk Factors MeSH
• Arrhythmias, Cardiac diagnosis   therapy   MeSH
• Heart Failure * complications   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Asia epidemiology   MeSH

Congestive heart failure (HF) is a progressive affliction defined as the inability of the heart to sufficiently maintain blood flow. Ventricular arrhythmias (VAs) are common in patients with HF, and conversely, advanced HF promotes the risk of VAs. Management of VA in HF requires a systematic, multimodality approach that comprises optimization of medical therapy and use of implantable cardioverter-defibrillator and/or device combined with cardiac resynchronization therapy. Catheter ablation is one of the most important strategies with the potential to abolish or decrease the number of recurrences of VA in this population. It can be a curative strategy in arrhythmia-induced cardiomyopathy and may even save lives in cases of an electrical storm. Additionally, modulation of the autonomic nervous system and stereotactic radiotherapy have been introduced as novel methods to control refractory VAs. In patients with end-stage HF and refractory VAs, an institution of the mechanical circulatory support device and cardiac transplant may be considered. This review aims to provide an overview of current evidence regarding management strategies of VAs in HF with an emphasis on interventional treatment.

• Keywords
• Catheter ablation, Heart failure, Implantable cardioverter-defibrillator, Sudden cardiac death, Ventricular arrhythmia,
• Publication type
• Journal Article MeSH

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

• Keywords
• Catheter ablation, Clinical document, Electrical storm, Electroanatomical mapping, Electrocardiogram, Expert consensus statement, Imaging, Premature ventricular complex, Radiofrequency ablation, Ventricular arrhythmia, Ventricular tachycardia,
• MeSH
• Catheter Ablation * MeSH
• Tachycardia, Ventricular * surgery   MeSH
• Ventricular Premature Complexes * MeSH
• Consensus MeSH
• Humans MeSH
• Cardiac Electrophysiology MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Systematic Review MeSH

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

• Keywords
• Catheter ablation, Clinical document, Electrical storm, Electroanatomical mapping, Electrocardiogram, Expert consensus statement, Imaging, Premature ventricular complex, Radiofrequency ablation, Ventricular arrhythmia, Ventricular tachycardia,
• MeSH
• Cardiology * MeSH
• Catheter Ablation standards   MeSH
• Tachycardia, Ventricular surgery   MeSH
• Consensus * MeSH
• Humans MeSH
• Societies, Medical * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Research Support, N.I.H., Extramural MeSH

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

• Keywords
• Catheter ablation, Clinical document, Electrical storm, Electroanatomical mapping, Electrocardiogram, Expert consensus statement, Imaging, Premature ventricular complex, Radiofrequency ablation, Ventricular arrhythmia, Ventricular tachycardia,
• MeSH
• Electrophysiologic Techniques, Cardiac methods   MeSH
• Catheter Ablation * instrumentation   methods   standards   MeSH
• Tachycardia, Ventricular * diagnosis   etiology   physiopathology   surgery   MeSH
• Ventricular Premature Complexes * diagnosis   etiology   physiopathology   surgery   MeSH
• Consensus MeSH
• Humans MeSH
• International Cooperation MeSH
• Heart Diseases classification   complications   MeSH
• Heart Conduction System pathology   physiopathology   surgery   MeSH
• Societies, Medical MeSH
• Cardiac Electrophysiology * organization & administration   standards   trends   MeSH
• Treatment Outcome MeSH
• Quality Improvement organization & administration   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH