Background: Recently there have been reports of LVAD patients presenting with multiple ineffective ICD shocks. In such patients, azygous vein coil placement by providing an alternative anterior-posterior trajectory of the electrical shock vector can enable successful defibrillation. Objective: This review provides a hands-on approach to azygous vein coil implantation. Additionally, we compare our tools and technique to those that have been previously described by other operators. Methods: From 2018 to 2021, 8 patients were identified who underwent azygous vein coil implantation at MedStar Washington hospital center using specific tools and technique. Demographic and procedural data were obtained by retrospective review of patient charts, procedure logs, fluoroscopy, and venography performed during device implantation. Results: The indication for azygous vein coil implantation was ineffective ICD shocks in 7 patients. The presenting rhythm was VF in 6/8 (75%) cases and sustained VT in 2/8 (25%) cases. Using the approach described, we were able to successfully implant an azygous vein coil in all 8 (100%) patients. There were no procedure-related complications. Post implantation, defibrillation testing (DFT) was successfully performed in 6/8 (75%) patients. One patient failed DFT testing despite the placement of an azygous vein coil. In another patient, DFT testing was not performed because the patient was in atrial fibrillation and was not systemically anticoagulated. Conclusion: Placement of an azygous vein coil in LVAD patients with failed ICD shocks using the tools and technique described in this review is safe and highly efficacious (successful in 100% cases).