Artificial muscles enable the design of soft implantable devices which are poised to transform the way we mechanically support the heart today. Heart failure is a prevalent and deadly disease, which is treated with the implantation of rotary blood pumps as the only alternative to heart transplantation. The clinically used mechanical devices are associated with severe adverse events, which are reflected here in a comprehensive list of critical requirements for soft active devices of the future: low power, no blood contact, pulsatile support, physiological responsiveness, high cycle life, and less-invasive implantation. In this review, we investigate and critically evaluate prior art in artificial muscles for their applicability in the short and long term. We highlight the main challenges regarding the effectiveness, controllability, and implantability of recently proposed actuators and explore future perspectives for attachment, physiological responsiveness, durability, and biodegradability as well as equitable design considerations.