CASH TRIAL: ICD vs. Antiarrhythmic Drug Treatment for VF or Sustained VT¹

CASH - Cardiac Arrest Study Hamburg

Protocol:

Hypothesis:

To compare the incidence of recurrence of cardiac arrest, sudden cardiac death, cardiac mortality, and total mortality in patients treated with antiarrhythmic drugs versus ICDs.

Primary endpoint:

Total mortality

Secondary endpoints:

• Recurrences of cardiac arrest requiring cardiopulmonary resuscitation
• Recurrences of hemodynamically unstable VT
• Incidence of drug withdrawal because of adverse effects
• Incidence of heart transplantation requirement

Status:

Start: 1987
Completion: 1998
Sample size: ICD (n=99) versus amiodarone (n=92), metoprolol (n=97), and propafenone (n=58, propafenone discontinued 3/92)

Results:

• Preliminary results showed that propafenone treatment is less effective than ICD treatment; therefore this arm was suspended. The ICD group experienced a 24% relative reduction in mortality with ICD (P=0.081).

Reference

1. Kuck K, Cappato R, Siebels J, et al. Randomized Comparison of Antiarrhythmic Drug Therapy with Implantable Defibrillators in Patients Resuscitated from Cardiac Arrest. Circulation. 2000;102-748-754.

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