Case Report
The patient is a 43-year-old male with non-ischemic cardiomyopathy, left ventricular ejection fraction of 15%, and paroxysmal atrial fibrillation who had an ICD implanted (Biotronik Intica 7 VRT DX). The patient presented with decompensated heart failure complicated by cardiogenic shock approximately 6 weeks post-implant. The patient was managed with inotropic therapy, an intra-aortic balloon pump, and evaluated for advanced therapies. A HeartMate III LVAD was placed as a bridge to transplant. Eleven months later, remote ICD monitoring reported persistent atrial fibrillation with periods of rapid ventricular rates resulting in inappropriate anti-tachycardia pacing and ICD shocks. With shared decision-making, it was decided to deactivate the tachyarrhythmia therapies. However, in-office interrogation of the ICD was unsuccessful. A pseudo-Faraday cage created by a cast-iron pan was placed on top of the ICD and failed. Successful interrogation and reprogramming were only achieved when the patient was instructed to extend his arm (on the ipsilateral side of the ICD) above his head, thus increasing the distance between LVAD and ICD from 4 cm (Fig 1) to over 10 cm, eliminating the interaction.