Response to the Editor: We thank Dr. Mitchell for expressing interest in our article and welcome the opportunity to address the issues that he raised. As correctly described by Dr. Mitchell, we delivered atrial shocks to patients in a clinical research hospital setting after an intravenous catheter had been placed; patients were in normal sinus rhythm. While being in a hospital may influence anxiety levels, there were no significant differences in self-reported state anxiety across time or between treatments. 1 Further, self-reported state anxiety scores in the inpatient study were not significantly different than those previously reported by the same patients in an ambulatory cardiology clinic setting (data not presented). The intense assessments during the study, including serial blood sample collections for analysis of plasma concentrations of triazolam and stress hormones, made it necessary to conduct this randomized, placebo-controlled trial in an inpatient setting. We agree that a follow-up study should be conducted in a more naturalistic setting to confirm the findings.We acknowledge the very important contributions that Dr. Mitchell and his colleagues have made to the literature with both the Atrial Defibrillator Sedation Assessment Studies, ADSAS and ADSAS-2. 2,3 In these studies, oral midazolam was administered prior to patient-activated atrial shock delivery in a community setting. We should have stated that "Our study was the first randomized, double blind, placebo-
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