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It was reported that this patient was scheduled for an implantable cardioverter defibrillator (icd) to cardiac resynchronization therapy defibrillator (crt-d) upgrade procedure with conduction system pacing (csp) lead placement.Csp lead placement was attempted, but there was no capture.The lv lead was removed, and the original icd was placed back into the pocket.Prior to the procedure, in-range shock impedances were noted.After placing the original icd back into the pocket, a low out-of-range shock impedance measurement of 0 ohms was observed.Visual inspection of the chronic right ventricular (rv) defibrillation lead confirmed there was no visible damage, and the physician opted to connect the chronic rv lead with the new icd.A low out-of-range shock impedance measurement of 0 ohms persisted with this new icd, and technical services (ts) was consulted for troubleshooting.Ts recommended turning off the electrocautery grounding pad, which resolved the out-of-range shock impedance measurement.The procedure was completed, and this icd remains in service.No adverse patient effects were reported.
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