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A case of difficult RV lead placement
  1. Amal Muthumala1,
  2. Neil Herring2,
  3. Kelvin Wong2
  1. 1Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
  2. 2Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford University Hospital NHS Trust, Oxford, UK
  1. Correspondence to Dr Amal Muthumala, Department of Cardiology, Liverpool Heart and Chest Hospital, Thomas Drive, Merseyside L14 3PE, UK; amal.muthumala{at}lhch.nhs.uk

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A 65-year-old man with ischaemic cardiomyopathy (EF 23%), NYHA class II–III heart failure symptoms and ECG showing LBBB with QRS duration of 150 ms underwent implantation of a Cardiac Resynchronisation Therapy Defibrillator (CRTD). The procedure was uneventful, and the pacing threshold and R wave amplitude during testing of the active dual coil lead were satisfactory.

Figure 1 showed a PA fluoroscopic image (1A), 12-lead ECG recorded during pacing from the defibrillator lead (1B), and injury current recording from the pacing system analyser (1C). Where is …

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