Having an ICD can allow for prompt termination of VA before significant hemodynamic consequences occur. Data on ICDs in patients with an LVAD are from observational series. A system- atic review of 6 observational studies observed that within 7 months, 26% of patients with an LVAD The death rate was lower among patients who previously had an ICD (16% versus 32%), suggesting a 39% relative-risk reduction in all-cause mortality in an adjusted analysis.S7.7.3-1 Patients with a history of pre-LVAD VA have nearly a 10-fold risk of post-LVAD VA.S7.7.3-2 S7.7.3-4 In many of the initial studies demonstrating ICD benefit, older pulsatile LVAD devices were in use.S7.7.3-2,S7.7.3-5 Studies of ICD use with the newer, continuous flow LVADs have inconsistently shown benefit.S7.7.3-1,S7.7.3- Of note, approximately 2 of 10 patients with an LVAD develop an LVAD related infection in the first year.S7.7.3-8,S7.7.3-9 7.7.4. ICD Use After Heart Transplantation Recommendation for ICD Use After Heart Transplantation References that support the recommendation are summarized in Online Data Supplement 37. COR LOE Recommendation IIb B-NR In patients with a heart transplant and severe allograft vasculopathy with LV dysfunction, an ICD may be reasonable if meaningful survival of greater than 1 year is expected.S7.7.4-1 S7.7.4-3 Recommendation-Specific Supportive Text 1. Development of disease in the transplanted heart places some patients at an increased risk of SCD that has ranged from 10% to 35% in Both rejection and a decreased LVEF are predictors of SCD. The mechanisms underlying SCD in patients with a heart transplant include damage to the conduc- tion system itself and VA due to coronary vas- culopathy or during episodes of acute rejection. 