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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.
What is the most likely cause for this man's CRT-D firing?
Lead migration …
Contributors PDM conceived the original idea for the article. PDM, EY and DRW were all involved in writing and editing of the manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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