Background-Left ventricular assist device (LVAD) treatment is known to lead to structural and functional cellular modifications in the heart. The relevance of these changes for clinical recovery is unknown. Methods and Results-We compared properties of cardiomyocytes obtained from tissue taken at explantation of the LVAD in patients with clinical recovery with those obtained from hearts of patients who did not show clinical recovery, thus requiring transplantation. Compared with myocytes taken at implantation, both the recovery and nonrecovery groups showed Ϸ50% reduction in cell capacitance, an index of cell size. However, action potential duration shortened, L-type Ca 2ϩ current fast inactivation was more rapid, and sarcoplasmic reticulum Ca 2ϩ content was increased in the recovery compared with the nonrecovery group. Conclusions-These results show that specific changes in excitation-contraction coupling, and not regression of cellular hypertrophy, are specifically associated with clinical recovery after LVAD and further identify sarcoplasmic reticulum Ca Key Words: mechanical devices Ⅲ electrophysiology Ⅲ heart failure Ⅲ myocytes Ⅲ sarcoplasmic reticulum H eart transplantation is currently the only effective longterm treatment for patients in end-stage heart failure. Recently, left ventricular assist device (LVAD) treatment has been used successfully as a bridge to transplantation, as destination therapy in patients with contraindications to transplantation, 1 or to obtain recovery in a small number of patients. 2,3 We have shown that in some patients with idiopathic dilated cardiomyopathy in end-stage heart failure, combined LVAD and pharmacological therapy induced clinical recovery to allow explantation of the device without recurrence of heart failure. 3 LVAD treatment results in numerous changes in cardiomyocyte phenotype, excitation-contraction coupling, gene expression, and function. 2 Whether these changes are beneficial is not known. Regression of hypertrophy is thought to be an important factor in recovery. 2 However, several studies have also shown that hypertrophy is not required as a compensatory response to pressure overload, 4 and its regression is not necessarily associated with normalization of electrophysiological parameters. 5 Cardiomyocytes isolated from biopsies taken at explantation of the LVAD in patients with clinical recovery showed reductions in cell volume and cell surface area. L-type Ca 2ϩ current and sarcoplasmic reticulum (SR) Ca 2ϩ content were increased in myocytes during recovery, suggesting a critical role for intracellular Ca 2ϩ homeostasis. 6 Increased SR Ca 2ϩ uptake in cardiac tissue after LVAD treatment has also been described previously. 7 However, whether these specific cellular changes are related to clinical recovery remained unclear.In this study, we compared findings in cardiomyocytes obtained from tissue taken from patients who recovered with those obtained from patients who, despite identical treatment, did not. This allowed correlation between cellular electroph...