A 76-year-old male patient with a history of non-ischemic cardiomyopathy with severe systolic dysfunction (LVEF of 15%), implanted with a dual-chamber ICD (Microport Platinum) for the primary prevention of sudden cardiac death, LV apical thrombus treated with oral anticoagulant, and ischemic stroke at the age of 71 years is admitted to the Cardiology Department for an episode of decompensated heart failure, presenting dyspnea on exertion and at rest, bilateral peripheral edema, and signs and symptoms that had progressively worsened during the previous 10 days prior to his presentation to the hospital. His ECG recorded at admittance is presented in Fig. 1.