A patient with a fourth-generation transvenous implantable cardioverter-defibrillator system nearly received an inappropriate defibrillation discharge while undergoing electrofulguration of keratotic facial skin lesions. The incident was confirmed by analyses of the implantable cardioverter-defibrillator's time/date stamped event log and stored electrogram record. Therapy was withheld by the noncommitted implantable cardioverter-defibrillator as the pulsed electrocautery was not continued beyond the charging period.