The shocking story of azimilide.

Initially tested for the secondary prevention of lifethreatening ventricular arrhythmias in survivors of cardiac arrest,1 the effectiveness of implantable cardioverterdefibrillator (ICD) therapy has recently been validated for the primary prevention of sudden cardiac death in high-risk patients with left ventricular (LV) dysfunction.2,3 Despite an improvement in survival (30% relative risk reduction) comparable to that of -blockers4 or angiotensin-converting enzyme (ACE) inhibitors,5 ICD therapy remains limited by impairment in quality of life in some of its recipients. As may be expected, the psychosocial consequences of device implantation, including anxiety disorders, depression, phobias, and sexual and employment problems, have been linked to the frequency of ICD discharges.6 In a recent publication, Godemann et al7 demonstrated a 3-fold increase in panic disorders and agoraphobia in patients with 2 ICD shocks annually. When severe enough, these symptoms necessitate psychiatric intervention8 or, in extreme cases, even device explantation.