4o This letter to the editor critiques the study on echocardiographic predictors of ventricular arrhythmias (VAs) in left ventricular assist device (LVAD) patients with pre-existing implantable cardioverter defibrillators (ICDs). While the study provides robust statistical analysis, its findings may not be generalizable to LVAD patients without ICDs. Additionally, the reliance on echocardiography alone limits the assessment of arrhythmic risk, as cardiac MRI with late gadolinium enhancement (LGE) could better evaluate myocardial fibrosis. The study also lacks data on antiarrhythmic therapy, which may influence post-LVAD VA incidence. Future research should incorporate advanced imaging, electrophysiological mapping, and pharmacologic strategies to refine risk prediction and improve patient outcomes.