Cardiac imaging in syndrome X: the problem of "reverse redistribution'.

patient with cardiac arrest, as initial presentation of the underlying cardiac disease, who receives an implantable cardioverter-defibrillator, cost cannot be evaluated, unless the first line therapeutic option for these patients is not an implantable cardioverter-defibrillator. Another approach could be to randomize these patients to an implantable cardioverter-defibrillator or to other forms of therapies (drugs, surgery) an approach similar to that used by Wever and Hauer. Randomization is not easy to undertake in patients with malignant ventricular arrhythmias as a therapy may be of particular benefit for a given patient. The German CASH trial comparing implantable cardioverter-defibrillator to antiarrhythmic therapy, is ongoing. The AVID trial, comparing the implantable cardioverter-defibrillator to treatment with amiodarone or sotalol, is expected to answer to a number of questions related to the use of implantable cardioverter-defibrillators. Whatever the results of these trials may be, they will limit but not prevent the use of implantable cardioverter-defibrillators. The latter have been shown to be effective in their objective of terminating ventricular arrhythmias and may be the only appropriate therapy in a selected group of patients. Cost-effectiveness therefore becomes particularly important. The other limitations of Valenti et al. concern the retrospective nature of the information collected during the 2 years preceding implantable cardioverter-defibrillator implantation and the 2 years following the implantation. Despite the limitations of this approach, their attempt to evaluate the impact of implantable cardioverterdefibrillators on rehospitalization and cost represents a useful addition to the literature on this important therapeutic modality. The results of the MADIT trial which were presented recently at NASPE concern the prophylactic use of an implantable cardioverterdefibrillator in patients who suffered a myocardial infarction and who were at high risk of sudden cardiac death. S. LEVY University of Marseille, Hopital Nord, France