Wearable cardioverter defibrillator: bridging for implantable defibrillators in left ventricular assist device patients

There is currently conflicting data available regarding the use of implantable cardioverter-defibrillators (ICD) in left ventricular assist device (LVAD) patients. While the benefit of an ICD in heart failure patients is well demonstrated, such benefit has failed to reach the LVAD population. In lack of randomized control trial data on the topic of ICD use in LVAD recipients, major societal guidelines are in disagreement when comes to the topic of routine implantation of a permanent defibrillator in prospective ventricular assist device patients. Alternative permanent defibrillator strategies have been suggested for the LVAD population such as subcutaneous implantable cardioverter defibrillators (S-ICDs) but eligibility of patients for such practice remains disappointing. Although most of the heart failure patients undergoing LVAD implantation already bear an ICD, clinicians are left with the decision of de novo implanting an ICD in an important number of patients. Wearable cardioverter defibrillators could prove beneficial in LVAD recipients by utilizing them as a bridge to decision towards the implantation of a permanent defibrillator.