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[Implantable cardioverter-defibrillators in patients with left ventricular assist devices : Current controversies]
Barbara Linz1, Thomas Pühler2, Julia Vogler3,4
1Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Haus A, 23538, Lübeck, Deutschland. Barbara.Linz@uksh.de.
Insights
The necessity of implantable cardioverter-defibrillators (ICDs) after left ventricular assist device (LVAD) implantation remains uncertain. Current evidence is inconclusive, necessitating individualized patient care decisions for both conventional and subcutaneous ICDs.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
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.
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