What combination of leads is typically seen in current implants?

The combination of leads typically seen in current implants involves a right atrial (RA) lead, a conduction system pacing (CSP) lead, usually placed in the left bundle branch (LBB), and an implantable cardioverter-defibrillator (ICD) lead in the right ventricle (RV). This configuration is designed to ensure effective pacing and synchronization of the heart, particularly in patients who have existing conduction abnormalities or heart failure.

The use of the RA lead allows for the electrical stimulation of the right atrium, which is essential for maintaining atrial contraction and coordinating with ventricular pacing. The CSP lead is crucial for capturing the conduction system in patients requiring advanced pacing strategies, as it provides more physiologic pacing compared to traditional right ventricular pacing alone. Furthermore, the ICD lead in the RV offers the necessary capability to deliver defibrillation in case of life-threatening arrhythmias, providing a comprehensive approach to managing cardiac rhythm disorders.

This combination addresses both pacing and arrhythmia management, reflecting the current trend in cardiac device therapy towards improving patient outcomes through more sophisticated pacing strategies.