Background: COPD is a common comorbidity in heart failure. The efficacy of implantable cardioverter-defi brillator (ICD) therapy has not been determined in patients with heart failure and COPD. Methods: We examined the incidence of ICD shocks and mortality in 628 consecutive patients who underwent defi brillator implantation at the Minneapolis Veterans Affairs Medical Center from 2006 to 2010. Results: The mean age of the patients was 67 ± 10 years, and 99% were men. Patients with COPD (n = 246 [39%]) were functionally more limited (P <.0001) and more likely to have an ICD for primary prevention of sudden death (P = .04) than those without COPD. Over a median 4.1 years (interquartile range [IQR] 2.2-5.7) of follow-up, patients with COPD had a higher incidence of appropriate shocks than those without COPD (29% vs 17%; P <.0001), whereas the incidence of inappropriate shocks was similar (9% vs 10%, P = .61). In multivariable analysis, COPD was associated with a twofold increase in the odds of an appropriate ICD shock (95% CI, 1.3-2.9; P = .001). Incidence of ICD shocks did not vary with severity of COPD. Although all-cause mortality was higher in patients with COPD than in those without COPD (29% vs 21%, P = .029), 1-year mortality (5.3% vs 2.6%, P = .08) and the average time from fi rst appropriate ICD shock to death was comparable (median, 2.3 [IQR, 1.2-4.4] vs 2.8 [IQR, 1.4-5.3] years; P = .29). Conclusions: Patients with COPD have a higher incidence of ICD shocks than those without COPD and appear to benefi t from ICD therapy.