Many of the advances that have been seen in the last decade concerning the functionality, size, and longevity of cardiac pacemakers have depended on concomitant advances in cardiac pacing leads. The current state of affairs of cardiac pacing leads is quite good in that leads have excellent electrical properties and appear to be more resistant to the hostile environment into which the lead is placed. Despite this, the goal of a perfect lead remains elusive, and there continue to be many challenges in lead design.

The components of a cardiac pacing lead are (1) a connector, (2) the conductor or conductors, (3) insulating materials, (4) the electrode or electrodes, and (5) the fixation mechanism. Although each of these is reviewed, the emphasis of this article is on the advances in the functional component of the lead that govern sensing and pacing.