Haqqani Haris M, Mond Harry G
Department of Cardiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
Pacing Clin Electrophysiol. 2009 Oct;32(10):1336-53. doi: 10.1111/j.1540-8159.2009.02492.x.
The prognostic benefit of the implantable cardioverter-defibrillator (ICD) has been well established in multiple settings and its use is consequently widespread. Modern-day ICD systems use transvenous high-voltage leads to act as the interface between the heart and the generator, allowing for the sensing of a cardiac activity and the delivery of both bradycardia and tachycardia therapy, including high-voltage, high-current shocks. The ICD lead is in many ways the most fragile and critical component of the ICD system, and is subjected to more stress than any other implanted medical device. It has similar components to a pacing lead including tip and ring electrodes, fixation mechanism, conductors, insulators, and connector pins. In addition, it also contains the high-voltage shock coils that allow the delivery of defibrillation therapy to the cardiac tissue. The materials used to manufacture each of these components have undergone little evolution from their initial pacing lead-derived origin, but promising progress in this area is now occurring and better conductors and insulators have been developed. Lead body design continues to be multiluminal rather than coaxial, but various iterations of this basic paradigm continue to be investigated. In addition to miniaturization of the entire ICD lead, new industry standard lead connectors will also be introduced to reduce complexity and pocket bulk. However, long-term failure rates have been considerable, with lead failure related to both conductor and insulator malfunction. It is hoped that recent improvements in an ICD lead design and manufacture will result in a good functionality with a reliable long-term performance.
植入式心脏复律除颤器（ICD）的预后益处已在多种情况下得到充分证实，因此其应用广泛。现代ICD系统使用经静脉高压导线作为心脏与发生器之间的接口，能够感知心脏活动并提供心动过缓和心动过速治疗，包括高电压、大电流电击。ICD导线在许多方面是ICD系统中最脆弱和关键的部件，承受的压力比任何其他植入式医疗设备都要大。它具有与起搏导线相似的部件，包括尖端和环形电极、固定机构、导体、绝缘体和连接销。此外，它还包含高压电击线圈，可将除颤治疗传递至心脏组织。用于制造这些部件的材料自最初源自起搏导线以来几乎没有改进，但该领域目前正在取得有前景的进展，已开发出更好的导体和绝缘体。导线主体设计仍然是多腔的而非同轴的，但这种基本范式的各种迭代仍在研究中。除了使整个ICD导线小型化外，还将引入新的行业标准导线连接器，以降低复杂性并减少植入部位的体积。然而，长期故障率一直相当高，导线故障与导体和绝缘体故障均有关。希望最近ICD导线设计和制造方面的改进将带来良好的功能以及可靠的长期性能。
