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Abstract A 62‐year‐old man with Brugada syndrome underwent subcutaneous implantable cardioverter defibrillator implantation. The lead was positioned along the left sternal border and defibrillation threshold (DFT) testing was performed. However, ventricular fibrillation (VF) was not terminated with 65 J and 80 J shocks. Shock impedance was 82 ohms. We repositioned the lead to the right sternal border and performed DFT testing again, followed by the VF termination with a 65 J shock. Shock impedance was 59 ohms. The positional relationship among the lead, generator, and heart was changed by lead repositioning, which may have contributed to improved shock impedance and DFT.

A 74-year-old woman who developed atrial tachycardia following the Cox-Maze IV procedure underwent catheter ablation. The reentrant circuit included the coronary sinus (CS), Marshall bundle (MB), distal MB-left atrial (LA) connection, and anterolateral mitral annulus. The distal MB-LA connection was the last barrier in the conduction pathway between the CS and the left atrium. Keywords: Atrial tachycardia, Catheter ablation, Coronary sinus, Left atrial appendage, Marshall bundle