A 64-year-old man with ischemic cardiomyopathy, refractory congestive heart failure (New York Heart Association Class III), and chronic atrial fibrillation undergoes implantion of an InSync Sentry™ 7299 CRT-D defibrillator. The morning after the implantation, he receives a shock while shaking his cardiologist's hand. The hospital telemetry during the handshake is shown in Fig. 113.1 (top panel), and episode report is shown in Fig. 113.1 bottom panel. Figure. 113.2 shows lead impedance values (top panel) taken following the shock, and the stored electrograms of the event (bottom panel). In order to identify the cause of the problem, detection is turned off, and various electrograms are recording during a provocative maneuver (hand shake), as shown in Fig. 113.3. Based on this information, what is your diagnosis? What is your recommended plan of action?
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