Implantable cardioverter-deﬁbrillator (ICD) therapy is clearly an effective therapy for selected patients in deﬁnable populations. The beneﬁts and risks of ICD therapy are directly impacted by programming and surgical decisions. This ﬂexibility is both a great strength and a weakness, for which there has been no prior ofﬁcial discussion or guidance. It is the consensus of the 4 continental electrophysiology societies that there are 4 important clinical issues for which there are sufﬁcient ICD clinical and trial data to provide evidence-based expert guidance. This document systemati- cally describes the greater than 80% (83%–100%, mean 96%) required consensus achieved for each recommendation by ofﬁcial balloting in regard to the programming of (1) bradycardia mode and rate, (2) tachycardia detection, (3) tachycardia therapy, and (4) the intraprocedural testing of deﬁbrillation efﬁcacy. Representatives nominated by the Heart Rhythm Society (HRS), European Heart Rhythm Association (EHRA), Asian Paciﬁc Heart Rhythm Society (APHRS), and the Sociedad Latinoamericana de Estimula- cion Cardiaca y Electroﬁsiologia (SOLAECE-Latin Amer- ican Society of Cardiac Pacing and Electrophysiology) participated in the project deﬁnition, the literature review, the recommendation development, the writing of the docu- ment, and its approval. The 32 recommendations were balloted by the 35 writing committee members and were approved by an average of 96%.