Background: Pro-arrhythmic influence of ICD lead, due to mechanical irritability of the myocardium, is a rare but recognised cause of refractory yet curable VT. Case Report: We report a case of 53-years-old female admitted with history of palpitations leading to shortness of breath- NYHA class II. 12-lead ECG elicited a monomorphic ventricle tachycardia (MMVT) with cycle length of 380-400ms. Her CMR revealed mild left ventricle (LV) dilatation with EF of 40%. Based on CMR appearance, a suspicion of sarcoidosis was raised. A dual chamber, single coil AICD lead (Guidant, Reliance 4 Front Serial Number 517356) was implanted in mid septal area of right ventricle (RV). Within 8 weeks following discharge, she represented with frequent symptomatic episodes of MMVT (CL 420-440 ms) with LBBB pattern and right superior axis, majority of which were paced terminated. Episodes of VT persisted, despite decent dose of sotalol (160 mg twice a day). During inpatient EP study VT was easily inducible with burst pacing. Activation and voltage mapping revealed low-voltage areas, near mid and posterior intra-ventricular septum. The earliest activation during VT was recorded 38ms ahead of QRS onset near the distal electrode of AICD lead. Suspicion of mechanically triggered VT by the ICD lead was raised. Her AICD lead was repositioned to RV apex, resulting in no sustained VT, recorded by the device at 6 months follow-up. Conclusion: Clinical vigilance can potentially lead to definite treatment for mechanically triggered VT by ICD lead. Fig. 1