Polyurethane (PU55D) and copolymer materials have low thermal stability and are highly susceptible to thermal damage during cautery. Implanting physicians should be aware of the lead insulation materials being used during implant procedures and their properties. The use of direct contact cautery on transvenous leads should be minimized to avoid damage to the lead, especially on leads with polyurethane or copolymer outer insulations.
The totally transvenous implantable defibrillator lead, conceived by Mirowski and Mower 45 years ago, is irrevocably related to the wide acceptance of this therapy. It paved the way for the era for non-thoracotomy implantation. This paper covers the most important details of the evolution--over this 45-year period--of the original (ENDOTAK) transvenous ICD lead and subsequent iterations. Over that time period, there have been over 800 000 patients implanted with this family of leads. The 'story' addresses the multiple problems encountered, technological improvements in materials, design, and testing to overcome them. And, the need for continued close collaboration between physicians and industry focused on reliability and longevity of this critical component of these life-saving systems.
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