Jacinthe Boulet1, Emmanuelle Massie1, Blandine Mondésert2,3, Yoan Lamarche4, Michel Carrier4, Anique Ducharme5,6. 1. Department of Medicine, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada. 2. Department of Medicine, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada. blandine.mondesert@umontreal.ca. 3. Adult Congenital Heart Disease Center, Montreal Heart Institute, 5000 Bélanger street, Montreal, Quebec, Canada. blandine.mondesert@umontreal.ca. 4. Department of Surgery Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada. 5. Department of Medicine, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada. anique.ducharme@umontreal.ca. 6. Heart Failure Clinic, Montreal Heart Institute, Research Center, 5000 Belanger street, Montreal, Quebec, Canada. anique.ducharme@umontreal.ca.
Abstract
PURPOSE OF REVIEW: While use of implantable cardioverter defibrillator (ICD) in patients with heart failure (HF) and reduced ejection fraction is recommended, their role in patients with left ventricular assist device (LVAD) remains controversial, especially with continuous flow (CF) devices. RECENT FINDINGS: Ventricular arrhythmias (VA) in LVAD patients are frequent and associated with worse outcomes, especially postoperatively. Data on the role of ICDs in LVAD patients are scarce, based on case reports or small retrospective series. While the majority of LVAD patients currently have an ICD, it seems that some might not derive any benefit, with additional risks in terms of inappropriate shocks, psychological distress, and infections. Some CF-LVAD patients are at high risk of VA and hemodynamic collapse; under those circumstances, an ICD might provide benefits. A randomized-controlled trial of routine ICD implantation in CF-LVAD would be needed to clarify their impact on survival in low risk patients.
PURPOSE OF REVIEW: While use of implantable cardioverter defibrillator (ICD) in patients with heart failure (HF) and reduced ejection fraction is recommended, their role in patients with left ventricular assist device (LVAD) remains controversial, especially with continuous flow (CF) devices. RECENT FINDINGS:Ventricular arrhythmias (VA) in LVAD patients are frequent and associated with worse outcomes, especially postoperatively. Data on the role of ICDs in LVAD patients are scarce, based on case reports or small retrospective series. While the majority of LVAD patients currently have an ICD, it seems that some might not derive any benefit, with additional risks in terms of inappropriate shocks, psychological distress, and infections. Some CF-LVAD patients are at high risk of VA and hemodynamic collapse; under those circumstances, an ICD might provide benefits. A randomized-controlled trial of routine ICD implantation in CF-LVAD would be needed to clarify their impact on survival in low risk patients.
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