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Current Heart Failure Reports

, Volume 16, Issue 6, pp 229–239 | Cite as

Current Review of Implantable Cardioverter Defibrillator Use in Patients With Left Ventricular Assist Device

  • Jacinthe Boulet
  • Emmanuelle Massie
  • Blandine MondésertEmail author
  • Yoan Lamarche
  • Michel Carrier
  • Anique DucharmeEmail author
Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (A Hasan, Section Editor)
  • 26 Downloads
Part of the following topical collections:
  1. Topical Collection on Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise

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.

Summary

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.

Keywords

Implantable cardioverter defibrillator Left ventricular assist device Heart failure Arrhythmias 

Abbreviations

ACEI

Angiotensin converting enzyme inhibitor

AF

Atrial fibrillation

ATP

Anti-tachycardia pacing

BNP

Brain natriuretic peptide

BTT

Bridge to transplantation

CF

Continuous flow

CRT

Cardiac resynchronization therapy

HF

Heart failure

HFrEF

Heart failure with reduced ejection fraction

HVAD

HeartWare ventricular assist device

ICD

Implantable cardioverter defibrillator

INTERMACS

Interagency Registry for Mechanically Assisted Circulatory Support

LBBB

Left bundle branch block

LVAD

Left ventricular assist device

MCS

Mechanical circulatory support

NYHA

New York Heart Association

PF

Pulsatile flow

QALY

Quality-adjusted life-years

RV

Right ventricle

SCD

Sudden cardiac death

S-ICD

Subcutaneous implantable cardioverter defibrillator

TV-ICD

Transvenous implantable cardioverter defibrillator

UNOS

United Network for Organ Sharing

VA

Ventricular arrhythmias

VF

Ventricular fibrillation

VT

Ventricular tachycardia

WCD

Wearable Cardioverter Defibrillator

Notes

Acknowledgments

Dr. Ducharme is the chair holder of the University of Montreal’s Foundation Marcelle and Jean Coutu and Cal and Janine Moisan for best practices in advanced heart failure.

Funding Information

Dr. Blandine Mondésert obtained a research grant from Boston Scientific and is on the advisory board and of Abbott, Biotronik, Boston Scientific, and Medtronic. Dr. Ducharme has received research grant from Novartis, Pfizer, and Servier and is on the advisory board of Akcea, Amgen, Astra-Zeneca, Novartis, Pfizer, and Servier.

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jacinthe Boulet
    • 1
  • Emmanuelle Massie
    • 1
  • Blandine Mondésert
    • 1
    • 2
    Email author
  • Yoan Lamarche
    • 3
  • Michel Carrier
    • 3
  • Anique Ducharme
    • 1
    • 4
    Email author
  1. 1.Department of Medicine, Institut de Cardiologie de MontréalUniversité de MontréalMontrealCanada
  2. 2.Adult Congenital Heart Disease CenterMontreal Heart InstituteMontrealCanada
  3. 3.Department of Surgery Institut de Cardiologie de MontréalUniversité de MontréalMontrealCanada
  4. 4.Heart Failure ClinicMontreal Heart Institute, Research CenterMontrealCanada

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