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A patient with severely impaired LV systolic function and New York Heart Association Class III symptoms presented with collapse and was found to have non-sustained ventricular tachycardia. The ECG demonstrated sinus rhythm with first-degree atrioventricular (AV) block and a widened QRS complex. On this basis, a cardiac resynchronisation therapy-defibrillator device was implanted. Leads were introduced via the left subclavian vein to the RV apex and right atrial (RA) appendage. Initial active fix parameters were RA—threshold 0.25 V, impedance 513 Ω, P 2.3 mV; dual coil RV—threshold 0.75 V, impedance 513 Ω, R …
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