Advanced heart failure: non-pharmacological approach


Patients with advanced heart failure have poor prognosis despite traditional pharmacological therapies. The early identification of these subjects would allow them to be addressed on time in dedicated centers to select patients eligible for heart transplantation or ventricular assistance. In this article we will report the current management of these patients based on latest international guidelines, underlining some critical aspects, with reference to future perspectives.

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  1. 1.

    Levy D, Kenchaiah S, Larson MG, Benjamin EJ, Kupka MJ, Ho KK, Murabito JM, Vasan RS (2002) Long-term trends in the incidence of and survival with heart failure. N. Eng J Med. 347:1397–1402

    Article  Google Scholar 

  2. 2.

    Dungen HD, Petroni R, Correale M, Coiro S, Monitillo F, Triggiani M, Leone M, Antohi EL, Ishihara S, Sarwar CMS, Sabbah HN, Memo M, Metra M, Butler J, Nodari S, Gheorghiade M (2018) A new educational program in heart failure drug development: the Brescia international master program. J Cardiovasc Med. 19:411–421

    Article  Google Scholar 

  3. 3.

    Crespo-Leiro MG, Metra M, Lund LH, Milicic D, Costanzo MR, Filippatos G, Gustafsson F, Tsui S, Barge-Caballero E, De Jonge N, Frigerio M, Hamdan R, Hasin T, Hülsmann M, Nalbantgil S, Potena L, Bauersachs J, Gkouziouta A, Ruhparwar A, Ristic AD, Straburzynska-Migaj E, McDonagh T, Seferovic P, Ruschitzka F (2018) Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 20:1505–1535

    PubMed  Article  Google Scholar 

  4. 4.

    Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, Van der Meer P (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18:891–975

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Lowey SE (2018) Palliative care in the management of patients with advanced heart failure. Adv Exp Med Biol. 1067:295–311

    PubMed  Article  Google Scholar 

  6. 6.

    Aspromonte N, Gulizia MM, Di Lenarda A, Mortara A, Battistoni I, De Maria R, Gabriele M, Iacoviello M, Navazio A, Pini D, Di Tano G, Marini M, Ricci RP, Alunni G, Radini D, Metra M, Romeo F (2016) Documento di consenso ANMCO/SIC. La rete cardiologica per la cura del malato con scompenso cardiaco: organizzazione dell’assistenza ambulatoriale. G Ital Cardiol. 17:570–593

    Google Scholar 

  7. 7.

    Craig M, Pereira NL (2006) Right heart catheterization and risk stratification in advanced heart failure. Curr Heart Fail Rep. 3:143–152

    PubMed  Article  Google Scholar 

  8. 8.

    Seguchi O, Hisamatsu E, Nakano A, Nakajima S, Kuroda K, Watanabe T, Sato T, Sunami H, Yanase M, Hata H, Hamasaki T, Fujita T, Kobayashi J, Nakatani T, Kitakaze M, Fukushima N (2017) Low partial pressure of end-tidal carbon dioxide predicts left ventricular assist device implantation in patients with advanced chronic heart failure. Int J Cardiol. 230:40–46

    PubMed  Article  Google Scholar 

  9. 9.

    Leeor M, Jaffe MD, Daniel P (2014) Morin. Cardiac resynchronization therapy: history, present status, and future directions. Ochsner J. 14:596–607

    Google Scholar 

  10. 10.

    Turitto G, El-Sherif N (2007) Cardiac resynchronization therapy: a review of proarrhythmic and antiarrhythmic mechanisms. Pacing Clin Electrophysiol. 30:115–122

    PubMed  Google Scholar 

  11. 11.

    Burns KV, Gage RM, Curtin AE, Gorcsan J 3rd, Bank AJ (2017) Left ventricular-only pacing in heart failure patients with normal atrioventricular conduction improves global function and left ventricular regional mechanics compared with biventricular pacing: an adaptive cardiac resynchronization therapy sub-study. Eur J Heart Fail. 19:1335–1343

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    Urbanek B, Kaczmarek K, Klimczak A, Ruta J, Chudzik M, Piestrzeniewicz K, Ptaszynski P, Wranicz JK (2017) Potential benefit of optimizing atrioventricular & interventricular delays in patients with cardiac resynchronization therapy. Indian J Med Res. 146:71–77

    PubMed  PubMed Central  Article  Google Scholar 

  13. 13.

    Kosztin A, Boros AM, Geller L, Merkely B (2018) Cardiac resynchronization therapy: current benefits and pitfalls. Kardiol Pol. 76:1420–1425

    PubMed  Article  Google Scholar 

  14. 14.

    Normand C, Linde C, Singh J, Dickstein K (2018) Indications for cardiac resynchronization therapy: a comparison of the major international guidelines. JACC Heart Fail. 6:308–316

    PubMed  Article  Google Scholar 

  15. 15.

    Gasparini M, Auricchio A, Regoli F, Fantoni C, Kawabata M, Galimberti P, Pini D, Ceriotti C, Gronda E, Klersy C, Fratini S, Klein HH (2006) Four year efficacy of cardiac resynchronization therapy on exercise tolerance and disease progression: the importance of performing atrioventricular junction ablation in patients with atrial fibrillation. J Am Coll Cardiol 48:734–743

    PubMed  Article  Google Scholar 

  16. 16.

    Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, Di Carlo L, De Mets D, White BG, DeVries DW, Feldman AM (2004) Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 350:2140–2150

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchel JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 62:e 147–239.

  18. 18.

    Auricchio A, Heggermont WA (2018) Technology advances to improve response to cardiac resynchronization therapy: what clinicians should know. Rev. Esp Cardiol. 71:477–484

    PubMed  Article  Google Scholar 

  19. 19.

    Marrouche NF, Brachmann J, Committee C-AS (2009) Catheter ablation versus standard conventional treatment in patients with left ventricular dysfunction and atrial fibrillation (CASTLE-AF)—study design. Pacing Clin Electrophysiol. 32:987–994

    PubMed  Article  Google Scholar 

  20. 20.

    Moss AJ, Schuger C, Beck CA, Brown MW, Cannom DS, Daubert JP, Estes NAM, Greenberg H, Hall WJ, Huang DT, Kautzner J, Klein H, McNitt S, Olshansky B, Shoda M, Wilber D, Zareba W (2012) Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med. 367:2275–2283

    CAS  PubMed  Article  Google Scholar 

  21. 21.

    Kloppe A, Proclemer A, Arenal A, Lunati M, Martìnez Ferrer JB, Hersi A, Gulaj M, Wijffels MC, Santi E, Manotta L, Mangoni L, Gasparini M (2014) Efficacy of long detection interval implantable cardioverter-defibrillator settings in secondary prevention population: data from the Avoid Delivering Therapies for Nonsustained Arrhythmias in ICD Patients III (ADVANCE III) trial. Circulation. 130:308–314

    CAS  PubMed  Article  Google Scholar 

  22. 22.

    Stone GW, Vahanian AS, Adams DH, Abraham WT, Borer JS, Bax JJ, Schofer J, Cutlip DE, Krucoff MW, Blackstone EH, Généreux P, Mack MJ, Siegel RJ, Grayburn PA, Enriquez-Sarano M, Lancellotti P, Filippatos G, Kappetein AP (2015) Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: Part 1: clinical trial design principles—a consensus document from the Mitral Valve Academic Research Consortium. J Am Coll Cardiol. 66:278–307

    PubMed  Article  Google Scholar 

  23. 23.

    Asgar AW, Mack MJ, Stone GW (2015) Secondary mitral regurgitation in heart failure: pathophysiology, prognosis, and therapeutic considerations. J Am Coll Cardiol. 65:1231–1248

    PubMed  Article  Google Scholar 

  24. 24.

    Goel SS, Bajaj N, Aggarwal B, Gupta S, Poddar KL, Ige M, Bdair H, Anabtawi A, Rahim S, Whitlow PL, Tuzcu EM, Griffin BP, Stewart WJ, Gillinov M, Blackstone EH, Smedira NG, Oliveira GH, Barzilai B, Menon V, Kapadia SR (2014) Prevalence and outcomes of unoperated patients with severe symptomatic mitral regurgitation and heart failure: comprehensive analysis to determine the potential role of MitraClip for this unmet need. J Am Coll Cardiol. 63:185–186

    PubMed  Article  Google Scholar 

  25. 25.

    Maisano F, Franzen O, Baldus S, Schäfer U, Hausleiter J, Butter C, Ussia GP, Sievert H, Richardt G, Widder JD, Moccetti T, Schillinger W (2013) Percutaneous mitral valve interventions in the real world: early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol. 62:1052–1061

    PubMed  Article  Google Scholar 

  26. 26.

    Obadia JF, Messika-Zeitoun D, Leurent G, Iung B, Bonnet G, Piriou N, Lefèvre T, Piot C, Rouleau F, Carrié D, Nejjari M, Ohlmann P, Leclercq F, Saint Etienne C, Teiger E, Leroux L, Karam N, Michel N, Gilard M, Donal E, Trochu JN, Cormier B, Armoiry X, Boutitie F, Maucort-Boulch D, Barnel C, Samson G, Guerin P, Vahanian A, Mewton N, MITRA-FR Investigators (2018) Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med. 379:2297–2306

    PubMed  Article  Google Scholar 

  27. 27.

    Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, Whisenant B, Grayburn PA, Rinaldi M, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Marx SO, Cohen DJ, Weissman NJ, Mack MJ, COAPT Investigators (2018) Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 379:2307–2318

    PubMed  Article  Google Scholar 

  28. 28.

    Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S, PARTNER Trial Investigators (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 363:1597–1607

    CAS  PubMed  Article  Google Scholar 

  29. 29.

    Deeb GM, Reardon MJ, Chetcuti S, Patel HJ, Grossman PM, Yakubov SJ, Kleiman NS, Coselli JS, Gleason TG, Lee JS, Hermiller JB Jr, Heiser J, Merhi W, Zorn GL 3rd, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Maini B, Mumtaz M, Conte J, Resar J, Aharonian V, Pfeffer T, Oh JK, Qiao H, Adams DH, Popma JJ, CoreValve US Clinical Investigators (2016) 3-year outcomes in high-risk patients who underwent surgical or transcatheter aortic valve replacement. J Am Coll Cardiol. 67:2565–2574

    PubMed  Article  Google Scholar 

  30. 30.

    Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ, PARTNER Trial Investigators (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 364:2187–2198

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    Mack MJ, Leon MB, Smith CR, Miller DC, Moses JW, Tuzcu EM, Webb JG, Douglas PS, Anderson WN, Blackstone EH, Kodali SK, Makkar RR, Fontana GP, Kapadia S, Bavaria J, Hahn RT, Thourani VH, Babaliaros V, Pichard A, Herrmann HC, Brown DL, Williams M, Akin J, Davidson MJ, Svensson LG, PARTNER 1 Trial Investigators (2015) 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomized controlled trial. Lancet 385:2477–2484

    PubMed  PubMed Central  Article  Google Scholar 

  32. 32.

    Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, Gleason TG, Buchbinder M, Hermiller J Jr, Kleiman NS, Chetcuti S, Heiser J, Merhi W, Zorn G, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Conte J, Maini B, Mumtaz M, Chenoweth S, Oh JK, U.S., CoreValve Clinical Investigators (2014) Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 370:1790–1798

    CAS  PubMed  Article  Google Scholar 

  33. 33.

    Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, Thourani VH, Tuzcu EM, Miller DC, Herrmann HC, Doshi D, Cohen DJ, Pichard AD, Kapadia S, Dewey T, Babaliaros V, Szeto WY, Williams MR, Kereiakes D, Zajarias A, Greason KL, Whisenant BK, Hodson RW, Moses JW, Trento A, Brown DL, Fearon WF, Pibarot P, Hahn RT, Jaber WA, Anderson WN, Alu MC, Webb JG, PARTNER 2 Investigators (2016) Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 374:1609–1620

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  34. 34.

    Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Muñoz DR, Rosenhek R, Sjögren J, Mas PT, Vahanian A, Wendler TWO, Windecker S, Zamorano JL, ESC Scientific Document Group (2017) 2017 ESC/EACTS Guidelines for the management of valvular heart disease The Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 38:2739–2791

    PubMed  Article  Google Scholar 

  35. 35.

    Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna W, Seward JB, Iwasaka T, Tsang TS (2006) Incidence and mortality risk of congestive heart failure in atrial fibrillation patients: a community-based study over two decades. Eur Heart J. 27:936–941

    PubMed  Article  Google Scholar 

  36. 36.

    Tsang TS, Gersh BJ (2002) Atrial fibrillation: an old disease, a new epidemic. Am J Med. 113:432–435

    PubMed  Article  Google Scholar 

  37. 37.

    Jons C, Jacobsen UG, Joergensen RM, Olsen NT, Dixen U, Johannessen A, Huikuri H, Messier M, McNitt S, Thomsen PE, Cardiac Arrhythmias and Risk Stratification after Acute Myocardial Infarction (CARISMA) Study Group (2011) The incidence and prognostic significance of new-onset atrial fibrillation in patients with acute myocardial infarction and left ventricular systolic dysfunction: a CARISMA substudy. Heart Rhythm. 8:342–348

    PubMed  Article  Google Scholar 

  38. 38.

    Cleland JG, Swedberg K, Cohen-Solal A, Cosin-Aguilar J, Dietz R, Follath F, Gavazzi A, Hobbs R, Korewicki J, Madeira HC, Preda I, van Gilst WH, Widimsky J, Mareev V, Mason J, Freemantle N, Eastaugh J (2000) The Euro Heart Failure Survey of the EUROHEART survey programme. A survey on the quality of care among patients with heart failure in Europe. The Study Group on Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology. The Medicines Evaluation Group Centre for Health Economics University of York. Eur J Heart Fail 2:123–132

    CAS  PubMed  Article  Google Scholar 

  39. 39.

    Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, D’Agostino RB, Murabito JM, Kannel WB, Benjamin EJ (2003) Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 107:2920–2925

    PubMed  Article  Google Scholar 

  40. 40.

    Mogensen UM, Jhund PS, Abraham WT, Desai AS, Dickstein K, Packer M, Rouleau JL, Solomon SD, Swedberg K, Zile MR, Køber L, McMurray JJV, PARADIGM-HF and ATMOSPHERE Investigators and Committees (2017) Type of atrial fibrillation and outcomes in patients with heart failure and reduced ejection fraction. J Am Coll Cardiol 70:2490–2500

    PubMed  Article  Google Scholar 

  41. 41.

    Arrigo M, Gayat E, Parenica J, Ishihara S, Zhang J, Choi DJ, Park JJ, Alhabib KF, Sato N, Miro O, Maggioni AP, Zhang Y, Spinar J, Cohen-Solal A, Iwashyna TJ, Mebazaa A, GREAT Network (2017) Precipitating factors and 90-day outcome of acute heart failure: a report from the intercontinental GREAT registry. Eur J Heart Fail. 19:201–208

    PubMed  Article  Google Scholar 

  42. 42.

    McMurray JJ, Ezekowitz JA, Lewis BS, Gersh BJ, van Diepen S, Amerena J, Bartunek J, Commerford P, Oh BH, Harjola VP, Al-Khatib SM, Hanna M, Alexander JH, Lopes RD, Wojdyla DM, Wallentin L, Granger CB, ARISTOTLE Committees and Investigators (2013) Left ventricular systolic dysfunction, heart failure, and the risk of stroke and systemic embolism in patients with atrial fibrillation: insights from the ARISTOTLE trial. Circ Heart Fail. 6:451–460

    CAS  PubMed  Article  Google Scholar 

  43. 43.

    Smer A, Salih M, Darrat YH, Saadi A, Guddeti R, Mahfood Haddad T, Kabach A, Ayan M, Saurav A, Abuissa H, Elayi CS (2018) Meta-analysis of randomized controlled trials on atrial fibrillation ablation in patients with heart failure with reduced ejection fraction. Clin Cardiol. 41:1430–1438

    PubMed  PubMed Central  Article  Google Scholar 

  44. 44.

    Jones DG, Haldar SK, Hussain W, Sharma R, Francis DP, Rahman-Haley SL, McDonagh TA, Underwood SR, Markides V, Wong T (2013) A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure. J Am Coll Cardiol. 61:1894–1903

    PubMed  Article  Google Scholar 

  45. 45.

    Hunter RJ, Berriman TJ, Diab I, Kamdar R, Richmond L, Baker V, Goromonzi F, Sawhney V, Duncan E, Page SP, Ullah W, Unsworth B, Mayet J, Dhinoja M, Earley MJ, Sporton S, Schilling RJ (2014) A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure (the CAMTAF trial). Circ Arrhythm Electrophysiol. 7:31–38

    CAS  PubMed  Article  Google Scholar 

  46. 46.

    Kheiri B, Osman M, Abdalla A, Haykal T, Ahmed S, Bachuwa G, Hassan M, Bhatt DL (2018) Catheter ablation of atrial fibrillation with heart failure: an updated meta-analysis of randomized trials. Int J Cardiol. 269:170–173

    PubMed  Article  Google Scholar 

  47. 47.

    Preobrazhenskii DV (2009) What is the optimal catheter approach for atrial fibrillation in chronic heart failure? Is it rhythm control or rate control? Results of PABA-CHF study. Kardiologiia. 49:70–71

    CAS  PubMed  Google Scholar 

  48. 48.

    Khan MN, Jaïs P, Cummings J, Di Biase L, Sanders P, Martin DO, Kautzner J, Hao S, Themistoclakis S, Fanelli R, Potenza D, Massaro R, Wazni O, Schweikert R, Saliba W, Wang P, Al-Ahmad A, Beheiry S, Santarelli P, Starling RC, Dello Russo A, Pelargonio G, Brachmann J, Schibgilla V, Bonso A, Casella M, Raviele A, Haïssaguerre M, Natale A, PABA-CHF Investigators (2008) Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. N Engl J Med. 359:1778–1785

    CAS  PubMed  Article  Google Scholar 

  49. 49.

    Di Biase L, Mohanty P, Mohanty S, Santangeli P, Trivedi C, Lakkireddy D, Reddy M, Jais P, Themistoclakis S, Dello Russo A, Casella M, Pelargonio G, Narducci ML, Schweikert R, Neuzil P, Sanchez J, Horton R, Beheiry S, Hongo R, Hao S, Rossillo A, Forleo G, Tondo C, Burkhardt JD, Haissaguerre M, Natale A (2016) Ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device: results from the AATAC multicenter randomized trial. Circulation 133:1637–1644

    PubMed  Article  CAS  Google Scholar 

  50. 50.

    Addison D, Farhad H, Shah RV, Mayrhofer T, Abbasi SA, John RM, Michaud GF, Jerosch-Herold M, Hoffmann U, Stevenson WG, Kwong RY, Neilan TG (2016) Effect of late gadolinium enhancement on the recovery of left ventricular systolic function after pulmonary vein isolation. J Am Heart Assoc. 5:e003570

    PubMed  PubMed Central  Article  Google Scholar 

  51. 51.

    Tzou WS (2018) Additional clarity provided through the lens of CAMERA-MRI: why patients with heart failure and atrial fibrillation may benefit from catheter ablation. JACC Clin Electrophysiol 4:1008–1010

    PubMed  Article  Google Scholar 

  52. 52.

    aus dem Siepen F, Buss SJ, Messroghli D, Andre F, Lossnitzer D, Seitz S, Keller M, Schnabel PA, Giannitsis E, Korosoglou G, Katus HA, Steen H (2015) T1 mapping in dilated cardiomyopathy with cardiac magnetic resonance: quantification of diffuse myocardial fibrosis and comparison with endomyocardial biopsy. Eur Heart J Cardiovasc Imaging 16:210–216

    PubMed  Article  Google Scholar 

  53. 53.

    Prabhu S, Taylor AJ, Costello BT, Kaye DM, McLellan AJA, Voskoboinik A, Sugumar H, Lockwood SM, Stokes MB, Pathik B, Nalliah CJ, Wong GR, Azzopardi SM, Gutman SJ, Lee G, Layland J, Mariani JA, Ling LH, Kalman JM, Kistler PM (2017) Catheter ablation versus medical rate control in atrial fibrillation and systolic dysfunction: the CAMERA-MRI Study. J Am Coll Cardiol. 70:1949–1961

    PubMed  Article  Google Scholar 

  54. 54.

    Prabhu S, Costello BT, Taylor AJ, Gutman SJ, Voskoboinik A, McLellan AJA, Peck KY, Sugumar H, Iles L, Pathik B, Nalliah CJ, Wong GR, Azzopardi SM, Lee G, Mariani J, Kaye DM, Ling LH, Kalman JM, Kistler PM (2018) Regression of diffuse ventricular fibrosis following restoration of sinus rhythm with catheter ablation in patients with atrial fibrillation and systolic dysfunction: a substudy of the CAMERA MRI trial. JACC Clin Electrophysiol 4:999–1007

    PubMed  Article  Google Scholar 

  55. 55.

    Prabhu S, Ling LH, Ullah W, Hunter RJ, Schilling RJ, McLellan AJ, Earley MJ, Sporton SC, Voskoboinik A, Blusztein D, Mariani JA, Lee G, Taylor AJ, Kalman JM, Kistler PM (2016) The impact of known heart disease on long-term outcomes of catheter ablation in patients with atrial fibrillation and left ventricular systolic dysfunction: a multicenter international study. J Cardiovasc Electrophysiol. 27:281–289

    PubMed  Article  Google Scholar 

  56. 56.

    Anselmino M, Matta M, D’ascenzo F, Pappone C, Santinelli V, Bunch TJ, Neumann T, Schilling RJ, Hunter RJ, Noelker G, Fiala M, Frontera A, Thomas G, Katritsis D, Jais P, Weerasooriya R, Kalman JM, Gaita F (2015) Catheter ablation of atrial fibrillation in patients with diabetes mellitus: a systematic review and meta-analysis. Europace 17:1518–1525

    PubMed  Article  Google Scholar 

  57. 57.

    Ullah W, Ling LH, Prabhu S, Lee G, Kistler P, Finlay MC, Earley MJ, Sporton S, Bashir Y, Betts TR, Rajappan K, Thomas G, Duncan E, Staniforth A, Mann I, Chow A, Lambiase P, Schilling RJ, Hunter RJ (2016) Catheter ablation of atrial fibrillation in patients with heart failure: impact of maintaining sinus rhythm on heart failure status and long-term rates of stroke and death. Europace. 18:679–686

    PubMed  Article  Google Scholar 

  58. 58.

    Marrouche NF (2018) Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, Merkely B, Pokushalov E, Sanders P, Proff J, Schunkert H, Christ H, Vogt J, Bänsch D; CASTLE-AF Investigators. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 378:417–427

    PubMed  Article  Google Scholar 

  59. 59.

    Packer DL, Mark DB, Robb RA, Monahan KH, Bahnson TD (2018) Moretz K, Poole JE, Mascette A, Rosenberg Y, Jeffries N, Al-Khalidi HR, Lee KL; CABANA Investigators. Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) Trial: study rationale and design. Am Heart J. 199:192–199

    PubMed  PubMed Central  Article  Google Scholar 

  60. 60.

    Baher A, Marrouche NF (2018) Treatment of atrial fibrillation in patients with co-existing heart failure and reduced ejection fraction: time to revisit the management guidelines? Arrhythm Electrophysiol Rev. 7:91–94

    PubMed  PubMed Central  Article  Google Scholar 

  61. 61.

    Pedrotty DM, Rame JE, Margulies KB (2013) Management of ventricular arrhythmias in patients with ventricular assist devices. Curr Opin Cardiol. 28:360–368

    PubMed  Article  Google Scholar 

  62. 62.

    Tzou WS, Tung R, Frankel DS, Vaseghi M, Bunch TJ, Di Biase L, Tholakanahalli VN, Lakkireddy D, Dickfeld T, Saliaris A, Weiss JP, Mathuria N, Tedrow U, Afzal MR, Vergara P, Nagashima K, Patel M, Nakahara S, Vakil K, Burkhardt JD, Tseng CH, Natale A, Shivkumar K, Callans DJ, Stevenson WG, Della Bella P, Marchlinski FE, Sauer WH. Ventricular tachycardia ablation in severe heart failure: an international ventricular tachycardia ablation center collaboration analysis. Circ Arrhythm Electrophysiol, 2017;10(1).

  63. 63.

    Baher A, Valderrabano M (2013) Management of ventricular tachycardia in heart failure. Methodist Debakey Cardiovasc J. 9:20–25

    PubMed  PubMed Central  Article  Google Scholar 

  64. 64.

    Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GY, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I, EP-Europace, UK (2014) EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Heart Rhythm. 11:e166–e196

    PubMed  Article  Google Scholar 

  65. 65.

    Carbucicchio C, Santamaria M, Trevisi N, Maccabelli G, Giraldi F, Fassini G, Riva S, Moltrasio M, Cireddu M, Veglia F, Della BP (2008) Catheter ablation for the treatment of electrical storm in patients with implantable cardioverter-defibrillators: short- and long-term outcomes in a prospective single-center study. Circulation. 117:462–469

    PubMed  Article  Google Scholar 

  66. 66.

    Mallidi J, Nadkarni GN, Berger RD, Calkins H, Nazarian S (2011) Meta-analysis of catheter ablation as an adjunct to medical therapy for treatment of ventricular tachycardia in patients with structural heart disease. Heart Rhythm. 8:503–510

    PubMed  Article  Google Scholar 

  67. 67.

    Ellenbogen KA, Kaszala K (2010) Ventricular tachycardia ablation: what have we learned from SMASH-VT. J Cardiovasc Electrophysiol. 21:804–805

    PubMed  Google Scholar 

  68. 68.

    Kuck KH, Schaumann A, Eckardt L, Willems S, Ventura R, Delacretaz E, Pitschner HF, Kautzner J, Schumacher B, Hansen PS, Vtach study group (2010) Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomized controlled trial. Lancet 375:31–40

    PubMed  Article  Google Scholar 

  69. 69.

    Santangeli P, Muser D, Maeda S, Filtz A, Zado ES, Frankel DS, Dixit S, Epstein AE, Callans DJ, Marchlinski FE (2016) Comparative effectiveness of antiarrhythmic drugs and catheter ablation for the prevention of recurrent ventricular tachycardia in patients with implantable cardioverter-defibrillators: a systematic review and meta-analysis of randomized controlled trials. Heart Rhythm. 13:1552–1559

    PubMed  Article  Google Scholar 

  70. 70.

    Sapp JL, Wells GA, Parkash R, Stevenson WG, Blier L, Sarrazin JF, Thibault B, Rivard L, Gula L, Leong-Sit P, Essebag V, Nery PB, Tung SK, Raymond JM, Sterns LD, Veenhuyzen GD, Healey JS, Redfearn D, Roux JF, Tang AS (2016) Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. N Engl J Med. 375:111–121

    CAS  PubMed  Article  Google Scholar 

  71. 71.

    Mathuria N, Wu G, Rojas-Delgado F, Shuraih M, Razavi M, Civitello A, Simpson L, Silva G, Wang S, Elayda M, Kantharia B, Singh S, Frazier OH, Cheng J (2017) Outcomes of pre-emptive and rescue use of percutaneous left ventricular assist device in patients with structural heart disease undergoing catheter ablation of ventricular tachycardia. J Interv Card Electrophysiol. 48:27–34

    PubMed  Article  Google Scholar 

  72. 72.

    Aryana A, Gearoid O’Neill P, Gregory D, Scotti D, Bailey S, Brunton S, Chang M, d’Avila A (2014) Procedural and clinical outcomes after catheter ablation of unstable ventricular tachycardia supported by a percutaneous left ventricular assist device. Heart Rhythm. 11:1122–1130

    PubMed  Article  Google Scholar 

  73. 73.

    Lu F, Eckman PM, Liao KK, Apostolidou I, John R, Chen T, Das GS, Francis GS, Lei H, Trohman RG, Benditt DG (2013) Catheter ablation of hemodynamically unstable ventricular tachycardia with mechanical circulatory support. Int J Cardiol. 168:3859–3865

    PubMed  Article  Google Scholar 

  74. 74.

    Ostadal P, Mlcek M, Holy F, Horakova S, Kralovec S, Skoda J, Petru J, Kruger A, Hrachovina V, Svoboda T, Kittnar O, Reddy VY, Neuzil P (2012) Direct comparison of percutaneous circulatory support systems in specific hemodynamic conditions in a porcine model. Circ Arrhythm Electrophysiol. 5:1202–1206

    PubMed  Article  Google Scholar 

  75. 75.

    Kumar S, Romero J, Mehta NK, Fujii A, Kapur S, Baldinger SH, Barbhaiya CR, Koplan BA, John RM, Epstein LM, Michaud GF, Tedrow UB, Stevenson WG (2016) Long-term outcomes after catheter ablation of ventricular tachycardia in patients with and without structural heart disease. Heart Rhythm. 13:1957–1963

    PubMed  Article  Google Scholar 

  76. 76.

    Stevenson WG, Friedman PL, Ganz LI (1997) Radiofrequency catheter ablation of ventricular tachycardia late after myocardial infarction. J Cardiovasc Electrophysiol. 8:1309–1319

    CAS  PubMed  Article  Google Scholar 

  77. 77.

    Stevenson WG, Sager P, Nademanee K, Hassan H, Middlekauff HR, Saxon LA, Wiener I (1992) Identifying sites for catheter ablation of ventricular tachycardia. Herz. 17:158–170

    CAS  PubMed  Google Scholar 

  78. 78.

    Frankel DS, Mountantonakis SE, Robinson MR, Zado ES, Callans DJ, Marchlinski FE (2011) Ventricular tachycardia ablation remains treatment of last resort in structural heart disease: argument for earlier intervention. J Cardiovasc Electrophysiol. 22:1123–1128

    PubMed  Article  Google Scholar 

  79. 79.

    Schroeder KL, Sallustio JE, Ross EA (2004) Continuous hematocrit monitoring during intradialytic hypotension: precipitous decline in plasma refill rates. Nephrol Dial Transplant. 19:652–656

    PubMed  Article  Google Scholar 

  80. 80.

    Schrier RW, Bansal S (2008) Pulmonary hypertension, right ventricular failure, and kidney: different from left ventricular failure? Clin J Am Soc Nephrol. 3:1232–1237

    PubMed  PubMed Central  Article  Google Scholar 

  81. 81.

    Costanzo MR, Ronco C, Abraham WT, Agostoni P, Barasch J, Fonarow GC, Gottlieb SS, Jaski BE, Kazory A, Levin AP, Levin HR, Marenzi G, Mullens W, Negoianu D, Redfield MM, Tang WHW, Testani JM, Voors AA (2017) Extracorporeal ultrafiltration for fluid overload in heart failure: current status and prospects for further research. J Am Coll Cardiol. 69:2428–2445

    PubMed  PubMed Central  Article  Google Scholar 

  82. 82.

    Costanzo MR, Saltzberg MT, Jessup M, Teerlink JR (2010) Sobotka PA; Ultrafiltration Versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure (UNLOAD) Investigators. Ultrafiltration is associated with fewer rehospitalizations than continuous diuretic infusion in patients with decompensated heart failure: results from UNLOAD. J Card Fail. 16:277–284

    PubMed  Google Scholar 

  83. 83.

    Giglioli C, Landi D, Cecchi E, Chiostri M, Gensini GF, Valente S, Ciaccheri M, Castelli G, Romano SM (2011) Effects of ULTRAfiltration vs. DIureticS on clinical, biohumoral and haemodynamic variables in patients with deCOmpensated heart failure: the ULTRADISCO study. Eur J Heart Fail. 13:337–346

    PubMed  Article  Google Scholar 

  84. 84.

    Marenzi G, Muratori M, Cosentino ER, Rinaldi ER, Donghi V, Milazzo V, Ferramosca E, Borghi C, Santoro A, Agostoni P (2014) Continuous ultrafiltration for congestive heart failure: the CUORE trial. J Card Fail. 20:9–17

    PubMed  Article  Google Scholar 

  85. 85.

    Toyoda Y, Guy TS, Kashem A (2013) Present status and future perspectives of heart transplantation. Circ J. 77:1097–1110

    CAS  PubMed  Article  Google Scholar 

  86. 86.

    Rose EA, Gelijns AC, Moskowitz AJ, Heitjan DF, Stevenson LW, Dembitsky W, Long JW, Ascheim DD, Tierney AR, Levitan RG, Watson JT, Meier P, Ronan NS, Shapiro PA, Lazar RM, Miller LW, Gupta L, Frazier OH, DesvigneNickens P, Oz MC (2001) Poirier VL; Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) Study Group. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 345:1435–1443

    CAS  PubMed  Google Scholar 

  87. 87.

    Gustafsson F, Rogers JG (2017) Left ventricular assist device therapy in advanced heart failure: patient selection and outcomes. Eur J Heart Fail. 19:595–602

    PubMed  Article  Google Scholar 

  88. 88.

    Miller LW, Pagani FD, Russell SD, John R, Boyle AJ, Aaronson KD, Conte JV, Naka Y, Mancini D, Delgado RM, Macgilliray TE, Farrar D, Frazier OH (2007) Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med. 357:885–896

    CAS  PubMed  Article  Google Scholar 

  89. 89.

    Rose EA, Gelijns AC, Moskowitz AJ, Heitjan DF, Stevenson LW, Dembitsky W, Long JW, Ascheim DD, Tierney AR, Levitan RG, Watson JT, Meier P, Ronan NS, Shapiro PA, Lazar RM, Miller LW, Gupta L, Frazier OH, Desvigne-Nickens P, Oz MC, Poirier VL (2001) Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 345:1435–1443

    CAS  PubMed  Article  Google Scholar 

  90. 90.

    Harjola VP, Mebazaa A, Celutkiene J, Bettex D, Bueno H, Chioncel O, Crespo-Leiro MG, Falk V, Filippatos G, Gibbs S, Leite-Moreira A, Lassus J, Masip J, Mueller C, Mullens W, Naeije R, Nordegraaf AV, Parissis J, Riley JP, Ristic A, Rosano G, Rudiger A, Ruschitzka F, Seferovic P, Sztrymf B, Vieillard-Baron A, Yilmaz MB, Konstantinides S (2016) Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology. Eur J Heart Fail 18:226–241

    PubMed  Article  Google Scholar 

  91. 91.

    Hasin T, Topilsky Y, Schirger JA, Li Z, Zhao Y, Boilson BA, Clavell AL, Rodeheffer RJ, Frantz RP, Edwards BS, Pereira NL, Joyce L, Daly R, Park SJ, Kushwaha SS (2012) Changes in renal function after implantation of continuous flow left ventricular assist devices. J Am Coll Cardiol. 59:26–36

    PubMed  Article  Google Scholar 

  92. 92.

    Mikus E, Stepanenko A, Krabatsch T, Loforte A, Dandel M, Lehmkuhl HB, Hetzer R, Potapov EV (2011) Reversibility of fixed pulmonary hypertension in left ventricular assist device support recipients. Eur J Cardiothorac Surg. 40:971–977

    PubMed  Google Scholar 

  93. 93.

    Stevenson LW, Couper G (2007) On the fledgling field of mechanical circulatory support. J Am Coll Cardiol. 50:748–751

    PubMed  Article  Google Scholar 

  94. 94.

    Estep JD, Starling RC, Horstmanshof DA, Milano CA, Selzman CH, Shah KB, Loebe M, Moazami N, Long JW, Stehlik J, Kasirajan V, Haas DC, O’Connell JB, Boyle AJ, Farrar DJ, Rogers JG (2015) Risk assessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients: results from the ROADMAP study. J Am Coll Cardiol. 66:1747–1761

    PubMed  Article  Google Scholar 

  95. 95.

    Wright GA, Rauf A, Stoker S, Alharethi R, Kfoury AG (2015) Marital status and survival in left ventricular assist device patient populations. J Heart Lung Transplant. 34:619–621

    PubMed  Article  Google Scholar 

  96. 96.

    Correale M, Ieva R, Pappalardo F, Santoro F, De Bonis M, Di Biase M (2013) Gastrointestinal bleeding and coagulation disorders in a patient with left-ventricular assist device. J Cardiovasc Med. 14:173–174

    Article  Google Scholar 

  97. 97.

    Mehra MR (2019) The burden of haemocompatibility with left ventricular assist systems: a complex weave. Eur Heart J. 40:673–677

    PubMed  Article  Google Scholar 

  98. 98.

    Mehra M, Naka Y, Uriel N, Goldstein DJ, Cleveland JC Jr, Colombo PC, Walsh MN, Milano CA, Patel CB, Jorde UP, Pagani FD, Aaronson KD, Dean DA, McCants K, Itoh A, Ewald GA, Horstmanshof D, Long JW (2017) Salerno C; MOMENTUM 3 Investigators. A fully magnetically levitated circulatory pump for advanced heart failure. N Engl J Med. 376:440–450

    PubMed  Google Scholar 

  99. 99.

    Rogers JG, Pagani FD, Tatooles AJ, Bhat G, Slaughter MS, Birks EJ, Boyce SW, Najjar SS, Jeevanandam V, Anderson AS, Gregoric ID, Mallidi H, Leadley K, Aaronson KD, Frazier OH, Milano CA (2017) Intrapericardial left ventricular assist device for advanced heart failure. N Engl J Med. 376:451–460

    PubMed  Article  Google Scholar 

  100. 100.

    Morshuis M, El-Banayosy A, Arusoglu L, Koerfer R, Hetzer R, Wieselthaler G, Pavie A, Nojiri C (2009) European experience of DuraHeart magnetically levitated centrifugal left ventricular assist system. Eur J Cardiothorac Surg. 35:1020–1027

    PubMed  Article  Google Scholar 

  101. 101.

    Morshuis M, Schoenbrodt M, Nojiri C, Roefe D, Schulte-Eistrup S, Boergermann J, Gummert JF, Arusoglu L (2010) DuraHeart magnetically levitated centrifugal left ventricular assist system for advanced heart failure patients. Expert Rev. Med Devices. 7:173–183

    PubMed  Article  Google Scholar 

  102. 102.

    Mehra M, Kobashigawa J, Starling R, Russell S, Uber P, Parameshwar J, Mohacsi P, Augustine S, Aaronson K, Barr M (2006) Listing criteria for heart transplantation: Inter-national Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates—2006. J Heart Lung Transplant. 25:1024–1042

    PubMed  Article  Google Scholar 

  103. 103.

    Banner NR, Bonser RS, Clark AL, Clark S, Cowburn PJ, Gardner RS, Kalra PR, McDonagh T, Rogers CA, Swan L, Parameshwar J, Thomas HL, Williams SG (2011) UK guidelines for referral and assessment of adults for heart transplantation. Heart. 97:1520–1527

    PubMed  Article  Google Scholar 

  104. 104.

    Stehlik J, Edwards LB, Kucheryavaya AY, Benden C, Christie JD, Dobbels F, Kirk R, Rahmel AO, Hertz MI (2011) The Registry of the International Society for Heart and Lung Transplantation: Twenty-eighth Adult Heart Transplant Report–2011. J Heart Lung Transplant. 30:1078–1094

    PubMed  Article  Google Scholar 

  105. 105.

    Deng MC, De Meester JM, Smits JM, Heinecke J, Scheld HH (2000) Effect of receiving a heart transplant: analysis of a national cohort entered on to a waiting list, stratified by heart failure severity: Comparative Outcome and Clinical Profiles in Transplantation (COCPIT) Study Group. BMJ. 321:540–545

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  106. 106.

    Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA, Danziger-Isakov L, Kirklin JK, Kirk R, Kushwaha SS, Lund LH, Potena L, Ross HJ, Taylor DO, Verschuuren EA, Zuckermann A (2016) The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update. J Heart Lung Transplant. 35:1–23

    PubMed  Article  Google Scholar 

  107. 107.

    Drakos SG, Kfoury AG, Gilbert EM, Horne BD, Long JW, Stringham JC, Campbell BA, Renlund DG (2007) Effect of reversible pulmonary hypertension on outcomes after heart transplantation. J Heart Lung Transplant. 26:319–323

    PubMed  Article  Google Scholar 

  108. 108.

    Tedford RJ, Hemnes AR, Russell SD, Wittstein IS, Mahmud M, Zaiman AL, Mathai SC, Thiemann DR, Hassoun PM, Girgis RE, Orens JB, Shah AS, Yuh D, Conte JV, Champion HC (2008) PDE5A inhibitor treatment of persistent pulmonary hypertension after mechanical circulatory support. Circ Heart Fail. 1:213–219

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  109. 109.

    Loh E, Bergin J, Couper G, Mudge GJ (1994) Role of panel-reactive antibody cross-reactivity in predicting survival after orthotopic heart transplantation. J Heart Lung Transplant. 13:194–201

    CAS  PubMed  Google Scholar 

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Correspondence to Natale Daniele Brunetti.

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Correale, M., Monaco, I., Tricarico, L. et al. Advanced heart failure: non-pharmacological approach. Heart Fail Rev 24, 779–791 (2019).

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  • Chronic heart failure
  • Advanced heart failure
  • Heart transplantation