**1. Introduction**

Left ventricular assist devices (LVADs) have become the standard treatment for patients with advanced heart failure who require prolonged mechanical circulatory support as a bridge to transplantation or as destination therapy [1–5]. The first generation of LVAD consisted of pulsatile pumps that were successful in unloading the heart, but they were limited by size and poor long-term durability. The second and third generations use continuous flow (i.e., Heartware or Heartmate II devices). Heartmate III is nowadays the only third-generation device available to implant due to its magnetic

levitation rotor related to lower rates of thrombus and hemolysis. One-year survival rates are approximately 80% and 70% at 2 years [4].

Patients with advanced HF have a major risk of sudden death due to ventricular dysrhythmias (VD). Therefore, an implantable cardioverter defibrillator (ICD) could be indicated. Primary prevention needs the device prescription before a fatal episode and is indicated if severe LVEF dysfunction (less than 35%) is diagnosed using any cardiac imaging tool such as transthoracic echocardiography or cardiac magnetic resonance, 40 days after myocardial infarction, despite full-medical protocol, the patient is not stable and if the estimation of the patient survival is more than 1 year. On the other hand, the secondary is indicated after ventricular arrhythmia [3, 6–9].

Patients in stage D often die of pump failure rather than sudden death, so ICD therapies have not been recommended in this population. Cardiac output impairment is less common [10] in LVAD subjects, and VD is better tolerated [3] than in the non-LVAD population. Moreover, inappropriate therapies and complex infections may increase the risk of ICD therapy. Therefore, ICD therapies remain controversial in the LVAD population, and further research is needed.
