To the Editor: In their study on the effects of antiarrhythmic drugs for prevention of shocks from implantable cardioverter defibrillators (ICDs), Dr Connolly and colleagues1 classified these shocks as appropriate due to ventricular tachycardia or ventricular fibrillation or inappropriate due to supraventricular tachycardia. However, inappropriate shocks could be from other sources that cannot be suppressed by antiarrhythmic medications,2 and therefore should not be included in analysis. Such shocks occur as a result of oversensing of T waves in patients with hypertrophic cardiomyopathy, oversensing due to fracture of the leads, or electromagnetic interference from a variety of sources. The authors did not mention the number of such shocks and whether they were excluded from the analysis.
They also did not state whether patients with arrhythmic storm (refractory ventricular tachycardia or ventricular fibrillation) were included in the study. Patients who develop arrhythmic storm are typically sicker, require frequent rehospitalization, have lower left ventricular ejection fraction, have overall poorer long-term prognosis, and sometimes require addition of another antiarrhythmic drug, such as procainamide or mexiletine.3 - 4 These patients frequently have recurrence of arrhythmic storm. Inclusion of such patients in the analysis would dilute the findings of this study.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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