A 62-year-old woman had previously received an implantable defibrillator due to a history of ventricular tachycardia. She presented following a shock that was not preceded by symptoms. A fracture of the right ventricular 6936 Transvene™ lead was identified as causing noise that led to inappropriate shock. Due to this, the 6936 lead was abandoned, the proximal electrodes capped, and a new Sprint™ 6945 lead placed in the right ventricular apex, taking care to avoid mechanical contact with the abandoned lead. The morning after implantation of the new lead, a pacing threshold test is performed (Fig. 107.1). On the basis of this tracing, what is your diagnosis?
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