The Role of Implantable Cardioverter Defibrillators for the Prevention of Ventricular Arrhythmia in Left Ventricular Assist Device Recipients

Advanced heart failure represents a significant strain on our health care system and is associated with increased morbidity and mortality. New device therapies, including left ventricular assist device (LVAD) implantation, have transformed management as both a destination therapy and as a bridge to transplantation. Although LVADs have improved patient outcomes, arrhythmias represent a significant and costly complication of this therapy. In recent years, implantable cardioverter-defibrillators (ICDs) have been developed to reduce the incidence of lethal arrhythmia. However, a gap in the literature exists for both guidelines in prevention of early ventricular arrhythmia (VA) in LVAD recipients and the effectiveness of ICDs when paired with various LVADs. Here, we clarify these guidelines and show that ICD selection should be tailored to the type of LVAD. We also show that subcutaneous ICDs represent an attractive alternative option for certain cohorts of patients, although transvenous ICDs remain a first-line choice at this time. Ultimately, understanding the various management options that affect outcomes in heart failure patients is important for treatment and clinical decision-making in an ever-growing population