An-Najah Staff

Patients with left ventricular assist devices (LVADs) are at high risk of sustained ventricular arrhythmias, but these may be remarkably well tol-
erated and the association with sudden death is unclear. Many patients who receive an LVAD already have an implantable cardioverter defibril-
lator (ICD). While it is standard practice to reactivate a previously implanted ICD in an LVAD recipient, this should include discussion of the
revised risks and benefits of ICD therapy following LVAD implantation. In particular, patients should be warned that they might receive a signifi-
cant number of ICD shocks that may not be life saving. When ICDs are reactivated, device programming should minimize the risk of repeated
shocks for non-sustained or well-tolerated ventricular arrhythmias. Implantation of a primary prevention ICD after implantation of an LVAD is
not supported by current evidence, poses potential risks, and should be the subject of a clinical trial before it becomes standard practice.