“…This is in addition to fatigue cracking which can be initiated in the elastomer at high localized loading conditions [15]. Due to the placement of the lead, there is also the potential for more complex wear mechanisms involving viscoelastic creep, persistence of wear products at the interface, as well as possible lubricating action of biological proteins in the cardiac environment [16]- [19]. Finally, the silicone elastomer itself is reinforced with a hard phase, usually silica particles, to enhance mechanical properties.…”