CRT-D implantation.

73 year old man was multiple risk factor and long history for chronic CAD. He had a cath 8 years ago showing triple vessel coronary artery disease with reduced LV function. No revascularization interventions were done at that time. He presented recently to ER with palptation and dizziness, ECG showed sustained monomorphic VT with HR 180 and hypotension requiring cardioversion. He was referred for ICD implation but ECG in sinus rhythm showed complete LBBB. Echo showed severely dilated LV with very poor LV systolic function. CRT-D implementation was the best therapy. LV lead was implemented easily through the CS into the LV lateral vein. Due to scared LV, LV threshold for capture was high and the only reasonable threshold was obtained from only one pole from the LV quadripolar leads in unipolar configuration. Appropriate programming was required to prevent inappropriate sensing of the pacing spike that may lead to double counting which could cause troubleshooting and inappropriate shocks.

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