Case summary S.S., a 38-year-old man, struck a cow while driving his vehicle. After the accident, while he was outside the vehicle inspecting the situation, he was anxious and shook his fist in frustration. He felt palpitations and associated dizziness. Almost immediately, he received an implantable cardioverter-defibrillator (ICD) shock that resolved the palpitations. No further sequelae occurred. He presented to our electrophysiology clinic for evaluation. S.S. has a history of nonischemic cardiomyopathy with bradycardia and is status postimplantation of a dual-chamber, biventricular Boston Scientific Contak Renewal 3 ICD. The ICD had been placed 4 years earlier for primary prevention due to viral dilated cardiomyopathy. The atrial lead is a Guidant 4136, the right ventricular lead is a Guidant 0185 integrated bipolar lead, and the left ventricular lead is a St. Jude 1056T bipolar lead. Device programmed and measured parameters are detailed in Table 1. Since implantation, the patient has experienced occasional episodes of nonsustained ventricular tachycardia (VT), for a total of five ventricular fibrillation (“VF”) events with a cycle length (CL) ranging from 243 to 278 ms. Since ICD implantation, he has received two shocks, one shock was 14 months earlier and the second of the two shocks as described above.