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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
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Current Review of Implantable Cardioverter Defibrillator Use in Patients With Left Ventricular Assist Device

Jacinthe Boulet1, Emmanuelle Massie1, Blandine Mondésert2,3

  • 1Department of Medicine, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada.

Current Heart Failure Reports
|November 27, 2019
PubMed

Insights

The role of implantable cardioverter defibrillators (ICDs) in patients with left ventricular assist devices (LVADs) is debated. While some patients may benefit, routine use requires further study to assess survival benefits and risks.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Implantable cardioverter defibrillators (ICDs) are recommended for heart failure (HF) with reduced ejection fraction.
  • The utility of ICDs in patients with left ventricular assist devices (LVADs), particularly continuous-flow (CF) devices, is controversial.

Purpose of the Study:

  • To review the current evidence and ongoing debate regarding the role of ICDs in LVAD patients.
  • To evaluate the risks and benefits of ICDs in the context of LVAD support.

Main Methods:

  • Review of existing literature, including case reports and small retrospective series.
  • Analysis of the frequency and outcomes of ventricular arrhythmias (VA) in LVAD patients.
  • Assessment of potential benefits and risks associated with ICDs in this population.

Main Results:

  • Ventricular arrhythmias (VA) are common in LVAD patients and linked to poorer outcomes.
  • Current data on ICD efficacy in LVAD patients are limited.
  • While many LVAD patients have ICDs, some may not benefit and face risks like inappropriate shocks and psychological distress.

Conclusions:

  • The benefit of routine ICD implantation in all LVAD patients is uncertain.
  • ICDs may offer advantages for specific CF-LVAD patients at high risk of VA and hemodynamic collapse.
  • A randomized controlled trial is necessary to determine the survival impact of routine ICDs in low-risk CF-LVAD patients.
Abstract

Keywords:
ArrhythmiasHeart failureImplantable cardioverter defibrillatorLeft ventricular assist device

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