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(Circulation. 2008;117:2721-2723.)
© 2008 American Heart Association, Inc.

Editorial

Implantable Cardioverter-Defibrillator Lead Performance

William H. Maisel, MD, MPH; Daniel B. Kramer, MD

From the Medical Device Safety Institute, Department of Medicine, Beth Israel Deaconess Medical Center (W.H.M.), and Department of Medicine, Massachusetts General Hospital (D.B.K.), Boston, Mass.

Correspondence to William H. Maisel, MD, MPH, Medical Device Safety Institute, Beth Israel Deaconess Medical Center, 185 Pilgrim Rd, Baker 4, Boston, MA 02215. E-mail wmaisel@bidmc.harvard.edu

Key Words: Editorials • death, sudden • defibrillation • registries • tachyarrhythmias

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Implantable cardioverter-defibrillators (ICDs) have revolutionized the treatment of patients at risk for sudden cardiac death. In the nearly 3 decades since the first human ICD implant,¹ millions of devices have been implanted worldwide and innumerable lives have been saved. Successful resuscitation of a potentially lethal ventricular arrhythmia by an ICD system depends on successful arrhythmia detection and timely delivery of therapy. Both the ICD generator and the ICD lead are critical components of this system. The lead, in particular, is literally a lifeline whose purpose is to convey critical information about the heart’s rhythm to the ICD generator and, in turn, to deliver life-sustaining therapy when needed. Failure of an ICD lead may result in significant clinical events, including failure to pace, failure to defibrillate, inappropriate shocks, and even death.

Article p 2727

ICD leads, like many medical technologies, have undergone a remarkable transformation. Epicardial leads, which necessitated a thoracotomy for lead placement, have given way to transvenous leads, which are easier to implant, less costly, and associated with decreased morbidity and mortality.² Important advances in transvenous lead technology, such as the development of steroid elution, smaller diameter leads, novel insulations, and multipolar leads, have translated into meaningful clinical benefits for patients. Although modern ICD leads consist primarily of electrodes, conductors, insulation, and a fixation mechanism to attach the lead to the myocardium, lead design and performance vary from model to model. Indeed, monitoring of performance is critical not only to identify products with increased failure rates but also to . . . [Full Text of this Article]

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