Sgarito Giuseppe, Campo Francesco, Sciacca Sergio, Pilato Michele, Cipriani Manlio, Conti Sergio
IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center, 90127 Palermo, Italy.
Division of Cardiology, Department of Internal Medicine, The Carver College of Medicine, University of Iowa Health Care Center, University of Iowa, Iowa, IA 52242, USA.
J Clin Med. 2025 Sep 19;14(18):6604. doi: 10.3390/jcm14186604.
Ventricular arrhythmias (VAs) are common and clinically important complications in patients supported by left ventricular assist devices (LVADs), occurring in up to 50% of cases within the first year after implantation. Despite the hemodynamic support provided by LVADs, VAs are linked to increased morbidity and mortality, primarily through recurrent implantable cardioverter defibrillator (ICD) shocks and right ventricular failure. The underlying mechanisms of VAs in this population are multifactorial, involving structural myocardial remodeling, device-related factors, and pre-existing arrhythmic substrates. Catheter ablation has become a valuable treatment option when antiarrhythmic drug therapy and device reprogramming are inadequate, though procedural timing (pre-, intra-, or post-implantation) and approaches remain under discussion. Epicardial access during LVAD surgery may provide advantages for selected patients, while ablation after implantation poses technical challenges due to altered anatomy and electromagnetic interference. This review offers a comprehensive overview of the epidemiology, pathophysiology, risk stratification, and management of VAs in LVAD recipients, emphasizing technical considerations, procedural safety, and clinical outcomes of catheter ablation. A multidisciplinary approach remains essential in guiding personalized treatment and optimizing outcomes for this complex population. Undergoing studies will provide more insight into optimal management of arrhythmias, particularly regarding the optimal timing of catheter ablation. The impact of new technologies such as non-invasive mapping alongside pre-procedural imaging needs also to be further evaluated.
室性心律失常（VAs）是接受左心室辅助装置（LVADs）支持的患者中常见且具有临床重要性的并发症，在植入后的第一年内发生率高达50%。尽管LVADs提供了血流动力学支持，但VAs与发病率和死亡率增加相关，主要是通过植入式心脏复律除颤器（ICD）反复电击和右心室衰竭。该人群中VAs的潜在机制是多因素的，涉及心肌结构重塑、与装置相关的因素以及既往存在的心律失常基质。当抗心律失常药物治疗和装置重新编程不足时，导管消融已成为一种有价值的治疗选择，不过手术时机（植入前、植入时或植入后）和方法仍在讨论中。LVAD手术期间的心外膜通路可能对特定患者具有优势，而植入后消融由于解剖结构改变和电磁干扰带来技术挑战。本综述全面概述了LVAD接受者中VAs的流行病学、病理生理学、风险分层和管理，强调导管消融的技术考量、手术安全性和临床结果。多学科方法对于指导这一复杂人群的个性化治疗和优化结果仍然至关重要。正在进行的研究将为心律失常的最佳管理提供更多见解，特别是关于导管消融的最佳时机。非侵入性标测等新技术与术前成像一起的影响也需要进一步评估。
