"Add-on pacing lead": an effective and safe alternative to lead replacement in ICD pacing failure

Despite recent advances in implantable cardioverter defibrillator (ICD) technology, the long-term reliability of ICD leads remains a significant problem. Lead failures constitute a major risk for patients with an implantable cardioverter defibrillator. There is no clear consensus on treatment strategy of ICD lead failure and decision should be individualized. We report a pacing-dependent elderly male with ICD lead pacing failure secondary to insulation break resulting in recurrent syncope. We emphasize the technique of "Add-on pacing lead implantation" could be an effective and alternative to ICD lead replacement.