Advances in ICD lead systems

We have presented both technical and clinical data indicating that transvenous lead systems are comparable to standard epicardial ICD systems with respect to efficacy. In addition there may be a reduction in morbidity when compared with the standard epicardial implant. We have shown for the Endotak and Transvene systems that each has its own idiosyncrasies, advantages, and disadvantages. Other lead systems are too early in their clinical evaluations for such definitive statements to be made. Regarding long-term reliability, the issues of mechanical integrity of the insulation and conductor materials, as well as the stability (or otherwise) of sensing and defibrillating characteristics remains to be determined for all lead systems. Similarly, compatibility between lead systems and pulse generators made by different manufacturers cannot be assumed, but needs to be prospectively examined in rigorous clinical trials.