1. American College of Cardiology Presented by Dr. Stuart J. Connolly
OPTIC Trial
Optimal Pharmacological Therapy in Implantable Cardioverter Defibrillator Patients Trial
Presented at
American College of Cardiology
Scientific Sessions 2005
Presented by Dr. Stuart J. Connolly

2. Beta-Blocker Alone Metoprolol, Carvedolol, or Bisoprolol
OPTIC Trial
412 patients receiving a St. Jude Medical dual chamber ICD,
with presence of one of the following: 1) spontaneous ventricular tachycardia (VT);
or 2) left ventricular (LV) ejection fraction ≤40% with either spontaneous ventricular fibrillation (VF) or inducible VT or VF.
Randomized
Beta-Blocker Alone Metoprolol, Carvedolol, or Bisoprolol
Sotalol
160 mg/day
Beta-Blocker
plus Amiodarone
800 mg load plus
200 mg/day
Endpoints (1 year):
Occurrence of shock (appropriate or inappropriate)
Presented at ACC Scientific Sessions 2005

3. Excluding Shocks During First 21 Days
OPTIC Trial
Any Shock at 1 Year
Any Shock at 1 Year
Excluding Shocks During First 21 Days
p<0.0001
p<0.0001
p=0.055
p=0.014
p=0.015
p=0.0057
Beta-blocker
Sotalol
Beta-Blocker
w/ Amiodarone
Beta-blocker
Sotalol
Beta-Blocker
w/ Amiodarone
Baseline clinical characteristics were similar between the treatment groups, with 80% of patients having had a prior MI, 29% having inducible VT or VF and 71% spontaneous VT or VF.
Presented at ACC Scientific Sessions 2005

4. OPTIC Trial Appropriate Shocks Inappropriate Shocks
Beta-blocker
Sotalol
Beta-Blocker
w/ Amiodarone
Beta-blocker
Sotalol
Beta-Blocker
w/ Amiodarone
Mean number of shocks per patient was 4.32 in the beta-blocker alone group, 0.93 in the sotalol group, and 0.51 of the amiodarone plus beta-blocker group. Adverse events were similar in the three groups.
Presented at ACC Scientific Sessions 2005

5. OPTIC Trial: Summary
Among patients receiving a dual chamber ICD for spontaneous or inducible VT or VF, sotalol therapy and amiodarone plus beta-blocker therapy were associated with reductions in shocks at 1 year compared with beta-blocker therapy alone.
The reductions in the amiodarone plus beta-blocker group were greater than the sotalol group.
The addition of amiodarone or sotalol was associated with reductions in shock without an increase in adverse events, suggesting these therapies may improve the quality of life in patients implanted with an ICD.
Presented at ACC Scientific Sessions 2005