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A shocking twist
  1. Paul D Morris1,2,3,
  2. Eron Yones1,
  3. David R Warriner1
  1. 1 Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  2. 2 Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
  3. 3 Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Paul D Morris, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S102RX, UK; paul.morris{at}sheffield.ac.uk

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Clinical introduction

A 61-year-old man presented to the ED after receiving multiple shocks from his cardiac resynchronisation therapy-defibrillator (CRT-D) device, implanted 2 months previously for New York Heart Association (NYHA) class III heart failure and left bundle branch block (LBBB). He had hiccoughs and was anxious but denied chest pain and dyspnoea. He had chronic atrial fibrillation (AF). He was haemodynamically stable but received several further unheralded shocks. The cardiac monitor appeared to show AF and LBBB throughout. His presenting chest radiograph is demonstrated in figure 1.

Figure 1

The ED chest radiograph.

Question

What is the most likely cause for this man's CRT-D firing?

  1. Lead fracture

  2. Lead migration …

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