Studies ex- ploring noninvasive risk factors for SCD in patients with HFpEF do not identify consistent factors with the exception of ischemic heart disease.S7.7.2-2,S7.7.2-6 Consequently, there is no accepted noninvasive test to identify high-risk patients with HFpEF. Invasive risk stratification with an electrophysiological study shows promise in this population.S7.7.2-7,S7.7.2-8 This topic is cur- rently being studied in the PRESERVE-EF (Risk Strati- fication in Patients With Preserved Ejection Fraction) trial (NCT02124018). Whether to include a recommendation related to an electrophysiological study in patients with HFpEF and ischemic heart disease was carefully considered by the writing committee. However, evidence was deemed insufficient to support a formal recommendation. Still, the pros and cons of an electrophysiological study can reasonably be considered in select patients with HFpEF and ischemic heart disease who are experiencing symp- toms suggestive of a VA. CLINICAL STATEMENTS AND GUIDELINES 7.7.3. Left Ventricular Assist Device Recommendation for Patients With an LVAD References that support the recommendation are summarized in Online Data Supplement 36. COR LOE Recommendation IIa C-LD In patients with an LVAD and sustained VA, an ICD can be beneficial.S7.7.3-1 Recommendation-Specific Supportive Text 1. Patients with an LVAD have a high risk of VA, particularly those with a history of The increased risk of VA may be due to myocardial irritation from insertion of the LVAD inflow cannula, LV compression due to a suctioning effect from the LVAD, inotropic support frequently needed by some patients, and repolar- ization changes that can occur after LVAD place- ment. Although VT/VF is tolerated by some patients with an LVAD, others experience a decrease in flow as the RV is unsupported; syncope and hypoperfu- sion can result. Having an ICD can allow for prompt termination of VA before significant hemodynamic consequences occur. 