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A 41‐year‐old man underwent implantation of a right‐sided implantable cardioverter defibrillator after removal of an infected left‐sided system. Defibrillation threshold (DFT) testing on the right‐sided system failed to convert ventricular fibrillation at maximum device output (35 J) compared with a DFT of less than 15 J on the previous left‐sided system. A single‐coil lead was selectively placed into the hemiazygous vein, which courses leftward of the spine in a posterior‐anterior projection, resulting in an improved shocking vector and reduction in DFTs to less than 25 J. (PACE 2012; 35:e10–e12)
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