Detecting dislodgement of a ventricular lead coupled to an implantable medical device comprises sensing a near-field cardiac EGM via a first electrode of the ventricular lead and a far-field cardiac EGM via a second electrode of the ventricular lead, identifying, R-waves in the near-field cardiac EGM and the far-field cardiac EGM. determining a near-field value of one or more R-wave amplitude metrics based on amplitudes of R-waves identified in the near-field cardiac EGM and a far-field value of the one or more R-wave amplitude metrics based on amplitudes of R-waves identified in the far-field cardiac EGM, detecting dislodgement of the ventricular lead based on at least one of the near-field value or the far-field value of the one or more R-wave amplitude metrics; and providing a lead dislodgment alert in response to detecting the dislodgement of the ventricular lead.