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In Reply: Dr Wase raises the issue of inappropriately delivered ICD shocks. In reviewing all ICD shocks in our trial, those not potentially influenced by antiarrhythmic drugs (ie, due to lead fractures or dislodgements) were rare. Only 1 inappropriate shock was delivered for T-wave oversensing and the rest were delivered for supraventricular tachyarrhythmias (primarily atrial fibrillation). None of the patients in the OPTIC study had hypertrophic cardiomyopathy, a condition in which T-wave oversensing by the ICD is more likely to result in inappropriate shock delivery. We did not enroll patients in our study who presented with arrhythmic storms; these patients usually require antiarrhythmic therapy.

Dr Coceani raises the question of the antiarrhythmic potential of the various -blockers used in our trial. There is some evidence of specific antiarrhythmic efficacy of carvedilol in experimental studies.^1-2 However, no properly designed clinical trial has compared the effects of carvedilol vs those of metoprolol . . . [Full Text of this Article]

Stefan H. Hohnloser, MD
J. W. Goethe University
Frankfurt, Germany

Robin S. Roberts, MTech
McMaster University
Hamilton, Ontario

Eric Fain, MD
St Jude Medical
Sylmar, Calif

Stuart J. Connolly, MD
connostu@phri.ca
McMaster University
Hamilton, Ontario

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