Techniques for performing a lead integrity test during a suspected tachyarrhythmia are described. An implantable medical device (IMD) may perform the test prior to delivering a therapeutic shock to treat the suspected tachyarrhythmia and, in some cases, may withhold the shock based on the test. In some examples, the IMD measures an impedance of a lead a plurality of times during the suspected tachyarrhythmia. In some examples, the IMD measures the impedance a plurality of times between two sensed events of the suspected tachyarrhythmia. The IMD or another device may determine a variability of, or otherwise compare, the measured impedances to evaluate the integrity of the lead. Instead of or in addition to withholding a shock, the IMD or another device may change a sensing or stimulation vector of the IMD, or provide an alert to a user, if the integrity test indicates a possible lead integrity issue.