Ventricular arrhythmias following left ventricular assist device implantation: a systematic review and meta-analysis of incidence and clinical impact

Ventricular arrhythmias (VAs) occur frequently following left ventricular assist device (LVAD) implantation. However, current evidence regarding their true incidence and impact remains limited.

We performed a systematic review and meta-analysis to assess the incidence and impact of post-LVAD VAs. PubMed/Embase/Cochrane databases were searched from inception to 1 April 2025, for studies reporting the occurrence of VAs following LVAD implantation. The primary outcome was the overall incidence of VAs. Secondary outcomes included the incidence of early (≤30 days) and late (>30 days) VAs, as well as electrical storm (ES) and their impact on all-cause mortality, assessed using incidence rate ratios (IRRs). Forty studies including 22 181 patients were analysed. The overall incidence of post-LVAD VAs was 2.43 (1.70–3.48) events per 100 person-months. Ventricular arrhythmia occurrence was significantly associated with increased all-cause mortality [IRR 1.32 (1.11–1.57)). The incidence of early VAs was 0.65 (0.48–0.88) events per 100 person-days (19.5 events per 100 patients over 30 days), and early VAs were associated with a higher risk of mortality [IRR 1.40 (1.18–1.67)]. Conversely, the incidence of late VAs was 2.05 (1.43–2.93) events per 100 person-months and was not significantly associated with mortality [IRR 0.85 (0.66–1.10)]. Electrical storm incidence was 0.44 (0.07–2.71) events per 100 person-months, significantly increasing all-cause mortality [IRR 1.34 (1.01–1.79)].

Ventricular arrhythmias are frequent following LVAD implantation and are associated with a significant impact on all-cause mortality—particularly when occurring early after implantation. Further studies are needed to optimize VA management and implantable cardioverter-defibrillator use.