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A 46‐year‐old female with a body mass index of 38.9 kg/m 2  and no organic heart disease underwent a subcutaneous implantable cardioverter‐defibrillator implantation for secondary prevention of sudden cardiac death in the setting of idiopathic ventricular fibrillation. Defibrillation threshold ( DFT ) testing during implantation detected high shock impedance and high  DFT . Fluoroscopy revealed subcoil fat between the lead and the sternum, which we suspected was the reason for the high shock impedance and high  DFT . We repositioned the lead to a site just above the sternum and the shock impedance and  DFT  improved to within the respective normal ranges.

High defibrillation threshold with a subcutaneous implantable cardiac defibrillator due to the lead having been positioned in the fat layer