It was reported that the patient arrived at the hospital in cardiac arrest and was intubated.The patient has a subcutaneous implantable cardioverter defibrillator (s-icd) implanted along with another manufacturer's cardiac resynchronization therapy pacemaker (crt-p) and epicardial leads in the abdomen.The epicardial leads appear to be the switched in the header as the unipolar right ventricle lead is connected in the left ventricle connector, and the bipolar left ventricle lead is connected in the right ventricle connector.Upon interrogation, the patient was in bi-ventricular pacing mode and the memory of the s-icd showed 11 shocks in seven episodes.The first five shocks were noted to be inappropriate and the last one of them induced the patient into ventricular fibrillation (vf).This arrhythmia was efficiently treated after four shocks in two different episodes.Therapy was exhausted in one of the episodes.X-ray was taken and new screening was performed to assess if a different location for the s-icd system would yield appropriate sensing.The screening passed in supine position using pacing bipolar mode.However, under the spontaneous rhythm the screening did not pass in any sensing vector due to low r to t ratios.It was further noted that there was high shock and system impedance.A revision procedure was performed where the s-icd and electrode were explanted.During the procedure it was noted that the system appeared to be more superficial with a subcutaneous pocket and no optimal lead placement.The new s-icd system was implanted with a new intermuscular pocket and a new vertical tunnelling.It was also placed higher and deeper than the previous system and yielded a good induction test along with within range measurements.No additional adverse patient effects were reported.
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