It was reported that the patient experienced diaphragmatic stimulation due to the left ventricular (lv) lead.The lv lead exhibited no capture consistently at higher outputs and unstable thresholds.The lv lead was capped and replaced.During the replacement procedure, the new left ventricular (lv) lead threshold measurements through the device and analyzer were different and unstable.When the cardiac resynchronization therapy pacemaker (crt-p) was connected with the new lv lead, there was no capture.Per the device, the threshold was high with lv tip to ring and lv tip to can.Different configurations were tried with the lv lead through the can, but the threshold remained high.The device was explanted and replaced.With the new device, the same issues continued and there was still a discrepancy between the analyzer and device measurements, but the thresholds had come down.Post-operative, the device was reprogrammed in the tip to can configuration.The device and lv lead remain in use.No further patient complications have been reported as a result of this event.
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