PMC6393888_01
Angiogram of the patient coronaries showing no culprit lesion or significant stenosis.
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fig1
Last page of the ICD memory showing 54 shocks in 1:15 h.
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fig2
ICD interrogation, which revealed an EOS (end of service) status and multiple inappropriate ICD therapies in the time between 00:07 AM and 03:46 AM until the battery of the Biotronik ICD was depleted and the device eventually stopped antitachycardia therapy. In summary, the patient suffered 105 consecutive inappropriate ICD shocks within 219 minutes (Figure 2), to our knowledge, the highest shock incidence in such a short period of time.
Inappropriate shock. Typical high-frequency signals (cluster) in the PS channel indicating a lead insulation problem.
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fig3
The shocks were caused by cluster missensing on her right ventricular lead (Figure 3), presumably resulting from an insulation defect near the header.