CASH

	Dr. Ricardo Capato from the University of Hamburg
discussed the Cardiac Arrest Study of Hamburg (CASH). This
was trial of the ICD versus 3 medical treatments: 
amiodarone, metoprolol or propafenone, for patients who 
had an out of hospital episode of ventricular fibrillation.
It was a small trial and only suggested a trend in favor 
of survival with ICD.
	The trial gave only 2 years of follow-up, and this
was extended to 5 years. A trend continued toward benefit
for ICD compared to drugs. There was no difference in
mortality between treatment with amiodarone and metoprolol.

Analyzing 3 Trials	

	Dr. Stuart Connolly from McMaster University, 
Ontario analyzed 3 trials of ICD versus medical therapy in
patients with cardiac arrest or SVT (sustained ventricular
tachycardia). These were AVID, CASH, and CIDS. These 3
studies were very similar in design and ideal for analysis.
	The main result was a strong benefit of ICD therapy,
with relative risk reduction of 27% for all-cause mortality.
Virtually all of that reduction was due to a reduction in 
arrhythmic death.
	The meta-analysis also examined whether there are
groups of patients who benefit more or less from ICD 
therapy. Patients with an ejection fraction less than 35%
had much benefit from the ICD and patients with an EF 
higher than 35% had virtually no benefit from the ICD.
	Patients who received their ICD by means of a 
non-thoracotomy implant had a better effect from the ICD
than patients who required a thoracotomy.
	ICD benefit was more or less independent of beta-
blocker use.