A meta-analysis of these studies suggested that an association exists be- tween ICD implantation and improved survival.S10.4-8 An important limitation is that only 2 studies specifi- cally studied patients with ESRD and most data ana- lyzed were from observational studies.S10.4-8,S10.4-9 In view of these limitations, the writing committee concluded there was not enough data to inform a recommenda- tion on ICD implantation in patients with ESRD on di- alysis. Decisions regarding ICDs in patients with CKD, especially those with ESRD, should be individualized and take into consideration the patient s functional sta- tus, number of comorbidities, and preferences, among other factors. 10.5. Valvular Heart Disease Patients with valvular heart disease should be evaluated and treated according to GDMT for valvular heart dis- ease and, when LVEF is depressed, GDMT that applies to NICM to reduce the risk of SCD.S10.6-23 VA in patients with valvular heart disease can be caused by any of the mechanisms responsible for VA in other cardiac disease including ischemic heart disease, MI, severe LV hyper- trophy, adrenergic-dependent rhythm disturbances, or an inherited molecular abnormality. Patients with valvular heart disease and VA are generally evaluated and treated using current recommendations for each The presence of a VA alone does not con- stitute an indication for valve repair or replacement. In general, there is more knowledge on the risk for SCD in patients with aortic stenosis than other valvular lesions with a risk of 1% to 1.5% per year.S10.6-2 Most patients who die suddenly have been symptomatic from their Although recurrent NSVT may place a patient with severe aortic stenosis at risk for syncope, the management of such a patient is guided by the severity of the valvular lesion. 