Beta blockers have been once again shown to be quite effective in long QT syndrome type 1. Even though conventional teaching is that beta blockers are quite effective in long QT syndrome type 1, several instances of beta blocker failure have prompted clinicians to implant cardioverter defibrillators in this group of patients. A retrospective analysis by Vincent GM et al (Circulation. 2009;119:215-221) has shown that beta blocker non compliance and the use of QT prolonging drugs are responsible for most of the so called beta blocker failures. The study involved 216 genotyped long QT syndrome type 1 patients treated with beta blockers and a median follow up of 10 years. While 73% had cardiac events before beta blocker therapy, 75% were asymptomatic on beta blockers. 92% of those who suffered cardiac arrest / sudden death were non compliant, on QT prolonging drugs or both. The authors suggest that routine implantation of cardioverter defibrillators (ICD) may not be necessary in those with long QT syndrome type 1 as the efficacy of beta blockers have been documented once more.