The implantable cardioverter defibrillator (ICD) reduces death in patients at risk for sustained ventricular arrhythmia, primarily by delivering high voltage shocks that terminate potentially fatal ventricular arrhythmias, according to background information in the article. ICD shocks are painful and patients may receive multiple ICD shocks. Such experiences are unpleasant and may lead to premature ICD battery depletion and continue to present a problem in the treatment of patients with ICD.
Antiarrhythmic drugs such as amiodarone and sotalol have the potential for reducing both appropriate and inappropriate shocks, but their relative efficacy to prevent shocks compared with standard therapy with a beta-blocker is unknown. Amiodarone has multiple effects on the heart; however, despite decades of use, it has never been compared with beta-blockers in a randomized controlled study. Sotalol is a beta-blocker with properties that are thought to help prevent ICD shocks, although previous studies have shown mixed results with this medication.
Stuart J. Connolly, M.D., of McMaster University, Hamilton, Ontario, Canada, and colleagues compared amiodarone plus a beta-blocker, sotalol alone, or standard beta-blocker therapy alone for prevention of ICD shocks in the OPTIC study. The randomized controlled trial included 412 patients from 39 out-patient ICD clinical centers located in Canada, Germany, United States, England, Sweden, and Austria, and was conducted from January 13, 2001, to September 28, 2004. Patients were eligible if they had received an ICD within 21 days for inducible or spontaneously occurring ventricular tachycardia (VT a rapid, abnormal heart rhythm) or ventricular fibrillation (VF). Patients were randomized to treat
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