TY - JOUR T1 - A shocking twist JF - Emergency Medicine Journal JO - Emerg Med J SP - 26 LP - 26 DO - 10.1136/emermed-2016-206347 VL - 34 IS - 1 AU - Paul D Morris AU - Eron Yones AU - David R Warriner Y1 - 2017/01/01 UR - http://emj.bmj.com/content/34/1/26.abstract N2 - 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.What is the most likely cause for this man's CRT-D firing?Lead fractureLead migration … ER -