**9. Conclusion**

There is not enough evidence to recommend the use of ICD in patients with LVAD because cardiac output impairment is less common, and VD is better tolerated than in the non-LVAD population.

The presence of VD and ischemic cardiomyopathy is a major risk for suffering VD events after an LVAD implant. VD usually occurs in the early period, the first month

after placement, and they usually have good tolerance due to Fontan-like circulation physiology. Although, up to 45% of patients experience symptoms, and 24% required cardioversion or defibrillation. But only up to 4% suffer syncope or 2% required support with RVAD.

Current guidelines are based on expert consensus and observational studies recommend ICD in the LVAD population if concomitant postoperative ventricular dysrhythmias associated with hemodynamic collapse are present, and its programming should be very conservative to avoid inappropriate shocks due to AT.

Until ICD therapies have been more thoroughly investigated and have shown significant evidence to benefit LVAD patients, there will be resistance to deactivating ICD, particularly in patient's bridge to transplant.
