It was reported that this cardiac resynchronization therapy defibrillator (crt-d) and left ventricular (lv) lead showed loss of capture (loc) on the presenting electrogram (egm).In addition, there were multiple high out-of-range pace impedance spikes greater than 3,000 ohms, and it was suspected that the lead-to-head connection was the cause.Technical services (ts) recommended evaluating pace vectors that did not use the ring.Additional information received reported that the patient experienced phrenic nerve stimulation in every other configuration, which is why this vector had been chosen.Thresholds taken that day were 1.5v and output was set to 2v; the safety margin was later increased and trend was programmed on.A twelve lead echocardiogram (ecg) was taken, and capture was confirmed.This crt-d system remains in service and will continue to be monitored.No additional adverse patient effects were reported.
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