PURPOSE OF REVIEW: The numbers of patients with ongoing mechanical circulatory support (MCS) is expanding significantly. These patients continue to have significant risk of both atrial and ventricular arrhythmias with few guidelines to suggest appropriate therapeutic strategies. Cardiologists need to understand the risks and therapeutic alternatives for the management of arrhythmias in this complex patient population. RECENT FINDINGS: Survival on MCS has steadily improved. Therefore, the duration of time during which the patients are at risk for both atrial and ventricular arrhythmias has increased. Drug-based and/or device-based therapeutic interventions are frequently required to mitigate these risks. SUMMARY: MCS has become the mainstream therapy for the end-stage heart failure population. Atrial arrhythmias in this population can lead to decompensated heart failure or thromboembolism and therapeutic interventions include rate control, rhythm control, and adjusted anticoagulation regimens. Ventricular arrhythmias in this population can lead to decompensated heart failure, syncope, and sudden cardiac death. Therapeutic interventions include volume replenishment, antiarrhythmic drug therapy, defibrillators, and adjustment of left ventricular assist device (LVAD) parameters. MCS may also be indicated in selected patients with refractory ventricular arrhythmias.
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