As more and more patients receive complex implantable cardioverter-defibrillators (ICDs), profound knowledge about the incidence of inappropriate device therapy, the reasons it happens, and the possibilities for prevention is crucial. In this article, the most important prevention algorithms incorporated in current ICD models and their advantages and handicaps are discussed in detail, which should help to guide the device selection for a particular patient. Also, emphasis is put on adjunctive drug therapy and interventional treatment strategies, which are crucial in managing patients with inappropriate ICD shocks.