Choosing the Device Generator and Leads: Matching the Device with the Patient

Several patient, device, and lead related characteristics should be considered prior to device implantation. Patient characteristics that determine the type of device implanted - single chamber, dual chamber or cardiac resynchronization therapy, include the underlying indication for pacing, presence of atrial arrhythmias, and indications for cardiac resynchronization. The implanting physician should also have a thorough understanding of lead design that affects lead performance, longevity, complications, and ease of extraction. Particular attention should be paid to the type of insulation, fixation mechanism, polarity, and compatibility of the generator and lead. Additional considerations for an implantable cardioverter-defibrillator (ICD) lead include sensing configuration (integrated vs. true bipolar) and defibrillation coil structure (single vs. dual). Coronary sinus leads should offer a low lead profile and flexibility to navigate the tortuous coronary venous system and stability to avoid dislodgement.