[Implantable cardioverter-defibrillators in patients with left ventricular assist devices : Current controversies].

BACKGROUND

Left ventricular assist devices (LVAD) are used to treat patients with advanced heart failure. A significant fraction of these patients simultaneously fulfill the indication for an implantable cardioverter-defibrillator (ICD).

OBJECTIVES

It is currently unclear whether patients require an ICD after LVAD implantation. In addition, it remains uncertain whether patients with an LVAD are suitable candidates for a subcutaneous ICD (S-ICD).

MATERIALS AND METHODS

The aforementioned questions were addresses using studies, case reports, and our own experience.

RESULTS

Studies have yielded varying findings on the above question. While some investigations suggest that an ICD may also be beneficial for LVAD patients, other studies highlight potential risks with limited benefit. This underscores the complexity of clinical decision-making in this specific patient cohort. S‑ICDs can suffer from significant functional impairments after LVAD implantation, making this combination controversial.

CONCLUSIONS

Due to the inconclusiveness of current studies, a general recommendation regarding the role of an ICD (both conventional and S‑ICD) after LVAD implantation cannot be established at this time. Therefore, it should involve individualized and interdisciplinary decision making.