This patient presented multiple episodes of non-sustained ventricular tachycardias detected in the VF zone (VF counter unfilled) but also slightly longer episodes with charging of the capacitors and sometimes non-effective one-shot ATP with subsequent spontaneous termination. These therapies could therefore be considered as appropriate but also as avoidable or unnecessary, the arrhythmia being terminated spontaneously. The programming of the number of intervals required for the initial detection is crucial for the quality of life of the patient, for his/her prognosis as well as for the lifespan of the device. Indeed, programming 30/40 for the initial detection would allow in this patient:

1. avoiding the repeated occurrence of capacitor charges with a significant impact on battery wear;
2. possibly reducing, as seen on the previous tracing, the number of inappropriate therapies due to lead dysfunction;
3. reducing the number of appropriate but avoidable therapies.

Associated with the programming of relatively high detection zones, this translates into primary prevention through a significant reduction in mortality. Treating an episode of malignant ventricular arrhythmia with electric shock remains the only option for achieving viable hemodynamics. On the other hand, the latest guidelines, based on all recent studies, suggest the need to avoid early and overly aggressive treatment of organized and slower ventricular arrhythmias. An electric shock can save a life but is associated with a deleterious effect of its own and should therefore be avoided whenever possible when spontaneous termination is possible or a less aggressive therapy can prove effective. It is therefore advisable

1. not to systematically program too low treatment zones in primary prevention;
2. extend the initial detection counters in the VT zone but also in the VF zone in order to avoid treating spontaneously terminating arrhythmia episodes (appropriate but avoidable therapies).

Likewise, it is desirable in this patient to avoid, as much as possible, the occurrence of bursts of antitachycardia pacing in the VF zone, which can prove to be, on the one hand, ineffective with moreover, a significant risk of accelerated progression of the arrhythmia into a very rapid rhythm disorder compromising the survival of the patient in the short term and requiring the delivery of one or more electrical shocks by the device.