What is the lead configuration for a BI-V ICD?

The lead configuration for a biventricular implantable cardioverter-defibrillator (BI-V ICD) typically includes a left ventricular lead, a right ventricular lead, and a right atrial lead, which allows for synchronized pacing of both ventricles as well as monitoring of cardiac rhythms.

In this configuration, the left ventricular (LV) lead is positioned in the coronary sinus to stimulate the left ventricle, facilitating better contraction and improving heart performance, particularly in patients with heart failure. The right ventricular (RV) lead is placed in the right ventricle, while the right atrial (RA) lead is placed in the right atrium to support overall cardiac function and provide necessary pacing when needed.

This configuration effectively helps in coordinating contractions all over the heart, particularly during biventricular pacing, which aims to enhance the efficiency of the heart's pumping action, thereby improving patient outcomes in those with certain types of heart failure or arrhythmias.

Other options like having only a left bundle branch (LBB) lead or combinations exclusively of one or two leads would not support the necessary biventricular pacing that is fundamental to a BI-V ICD's function.