What is the protocol for patients with LVAD regarding cardioversion?

• A. LVADs are contraindicated for cardioversion
• B. LVADs must be removed prior to defibrillation
• C. LVADs are not a contraindication for cardioversion or defibrillation
• D. LVADs require prior authorization for defibrillation

Answer: (C)

In patients with an LVAD, electrical shocks to correct dangerous rhythms are still used just as in other patients. The LVAD is implanted and designed to tolerate external defibrillation, so the device does not need to be removed or protected by special steps before cardioversion or defibrillation. When VT or VF or another life-threatening rhythm is present, you proceed with defibrillation as indicated, and then reassess the rhythm. Pad placement can follow standard defibrillation protocols, and there’s no need for prior authorization. Keep in mind that a pulse may be unreliable with an LVAD, so rely on ECG and arterial monitoring rather than pulse alone.