The case described here represents the first amiodarone-treated patient for whom a fully documented report is available at the occurrence of sudden death. According to the criteria of the study protoco12,3 the patient had been classified among the responders to antiarrhythmic therapy and after the first period of the trial his subjective report did not suggest any relevant symptoms during the month before sudden death. Examination the day of death gave findings similar to the previous ones if one excludes an increase in heart rate (from 59 to 75 beats/min). The possible relation of amiodarone treatment with the thyroid status4 suggests the importance of close monitoring of thyroid function. No clear inference could be drawn from absolute drug concentrations or their ratios. The 2 different regimens of amiodarone (400 and 200 mg) in the 2 study periods did not seem to modify blood drug concentrations, which, however, were not correlated to drug efficacy. The pattern of distribution of amiodarone in various organs confirms the expected preferential concentration in lipid-rich tissues. The very high ratio for lungs, although not associated with any clinical or objective findings, should be viewed in the light of repeated reports of relevant pulmonary side effeck5 The relatively small amount of amiodarone found in the thyroid gland could support the hypothesis of a peripheral action of the drug.6 Conversely, the relatively high whole heart tissue concentration reveals little about the level-efficacy relationship.