KEY TEACHING POINTS

•Epicardial device leads can be a trigger for ventricular arrhythmia, even if they have been quiescent for many years. •Epicardial device leads can cause ventricular arrhythmia without any obvious endocardial substrate abnormalities. •Unusual provocation maneuvers should be considered outside of the standard ventricular pacing protocols, isoproterenol, and epinephrine. This should be guided by a careful history identifying unconventional triggers.