A 24-year-old woman with complex congenital heart disease, depressed systemic ventricular function, and congestive heart failure previously received an InSync II Marquis™ 7289 CRT-D utilizing a Medtronic Sprint Fidelis 6949 right ventricular defibrillation lead, 4193 left ventricular lead, and a Novus 5076 right atrial lead. While in hospital on telemetry, she develops recurrent episodes of pacing failure, ventricular arrhythmias, and shocks (Fig. 117.1). The device status report is shown in Fig. 117.2. In order to further troubleshoot the device malfunction, a real-time electrogram and surface ECG are simultaneously recorded (Fig. 117.3). What is the diagnosis? How is the problem corrected?
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