A 73-year-old man with coronary artery disease, hypertension, and depressed ventricular function presents after receiving multiple shocks from his single chamber ICD. On physical examination, the blood pressure is 148/73, with heart rate 86. The jugular venous distension measures 8 cm, lungs are clear, gallops are absent, the abdomen is unremarkable, and trace lower extremity edema is noted. Figure 108.1 shows the VT/VF episode list. A representative episode is shown in Fig. 108.2. Based on this, what is your diagnosis? Do you recommend device reprogramming or surgical system revision?
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