Assessment of a Chronically Implanted Parasternally Delivered EV-ICD Lead (ASCEND EV) Study

1. At least 18 years old
2. Class I or IIa indication for implantation of an ICD according to the ACC/AHA/HRS Guidelines or ESC guidelines

Exclusion Criteria:

1. Participation in any concurrent clinical study without prior written approval from the Sponsor
2. Inability or unwillingness to provide informed consent to participate in the Study
3. Any known conditions which may complicate the AtaCor EV-ICD Lead System implant procedure or prevent the subject from completing protocol testing through the 3-month follow-up visit
4. Circumstances that may prevent data collection or completion of specified follow-up visits
5. Allergies to any device materials listed in the Instructions for Use (IFU)
6. Subjects on anticoagulation therapy that cannot be temporarily discontinued for the procedure

7. Known history of lung disease with FEV1 \< 1.0 Liter

   Device Related:

8. Presence or planned use of medical devices that introduce current into the body (e.g., pacemaker, LVAD, neurostimulator, etc.)
9. Implanted with or planned implantation of any device which delivers current in the body, that may interfere with therapy delivery, including, but not limited to a pacemaker, or neurostimulator
10. Presence or planned use of a subcutaneous ICD lead, subcutaneous coils/arrays, epicardial patches or epicardial pace/sense leads

11. Any known need for future MRI

    Anatomy Related:

12. BMI ≥ 35 kg/m2
13. Structural abnormalities of the heart that may increase risk of the study procedure or an obstructed/restricted pathway into the mediastinum
14. Prior sternotomy of any type, including but not limited to median, mini or clamshell
15. Prior surgery with disruption of the lung, pericardium or connective tissue between the sternum and pericardium
16. Known significant anatomic derangement of or within the thorax (e.g., pectus excavatum, significant scoliosis) and associated with displacement of the heart or lungs or impeded mediastinal access.
17. History of thoracic radiation therapy, pneumothorax, pneumomediastinum or other medical treatments/conditions which may complicate the AtaCor EV-ICD Lead System implant procedure
18. Known adhesions in the thorax or history of medical treatments, surgeries or conditions that increase the potential for adhesions in the thorax

19. Surgically corrected congenital heart disease (not including catheter-based procedures)

    Cardiac Related:

20. Subjects who require permanent bradycardia pacing or cardiac resynchronization therapy
21. NYHA IV functional class in past 90 days
22. Inotropic therapy in past 180 days
23. Known history of pericardial disease, pericarditis or mediastinitis

24. Patients with a medical condition that precludes them from undergoing defibrillation testing:

    • Severe aortic stenosis
    • Current Intracardiac LA or LV thrombus
    • Severe proximal three-vessel or left main coronary artery disease without revascularization
    • Hemodynamic instability
    • Unstable angina
    • Recent stroke or transient ischemic attack (within the last 6 months)
    • Known inadequate external defibrillation
    • LVEF \< 20%
    • LVEDD >70 mm