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January 11, 2006

Antiarrhythmic Drugs for All Patients With an ICD?

JAMA. 2006;295(2):211-213. doi:10.1001/jama.295.2.211

In the early stages of implantable cardioverter defibrillator (ICD) use, the combination of antiarrhythmic drug concurrent with the device seemed redundant, akin to “a belt plus suspenders.” Before long it was discovered that, over time, most patients eventually required antiarrhythmic medication in addition to the ICD. In this issue of JAMA, the results of the Optimal Pharmacological Therapy in Cardioverter Defibrillator Patients (OPTIC) trial reported by Connolly and colleagues1 raise the issue of whether antiarrhythmic therapy, plus a β-blocker, should be initiated at the time of initial ICD implantation in an effort to reduce the likelihood of ICD shock. To respond to this question, it is important to examine the interaction of antiarrhythmic drug therapy with the ICD, and the consequences of such a combination.