This is the case of a 77-year-old man with hypertension, diabetes, ischemic cardiomyopathy, heart failure, and an extensive device history. In May 2005, he underwent implantation of a right-sided biventricular implantable cardioverter defibrillator (ICD) system (Medtronic Insync Maximo 7303), Capsure Fix Novus 4076 atrial lead (Medtronic), Sprint Fidelis 6949 right ventricular (RV) dual coil ICD lead (Medtronic), and Attain OTW Bipolar 4194 left ventricular (LV) lead (Medtronic). In September 2007, he was using his right arm to dig a ditch and lay bricks. The next day while holding up a newspaper to read, he received multiple shocks. He was taken to a local emergency room where his ICD was reprogrammed to prevent shocks, and he was transferred to our facility for management.