Author + information
- Received April 11, 2019
- Revision received July 2, 2019
- Accepted July 3, 2019
- Published online October 21, 2019.
- Fabio Mahamed Rassi, MDa,b,
- Lucas Minohara, MDb,
- Anis Rassi Jr., MD, PhDa,∗ (, )
- Luis Claudio Lemos Correia, MD, PhDc,
- José Antonio Marin-Neto, MD, PhDd,
- Anis Rassi, MDa and
- Antonio da Silva Menezes Jr., MD, PhDb
- aHospital do Coração Anis Rassi, Goiânia, Brazil
- bPontifícia Universidade Católica de Goiás, Escola de Ciências Médicas, Farmacêuticas e Biomédicas, Goiânia, Brazil
- cMedical and Public Health School of Bahia, Salvador, Brazil
- dRibeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- ↵∗Address for correspondence:
Dr. Anis Rassi Jr., Hospital do Coração Anis Rassi, Avenida José Alves 453, Setor Oeste, Goiânia (GO) 74110-020, Brazil.
Objectives The goal of this analysis was to pool data from published studies on outcomes after implantable cardioverter-defibrillator (ICD) therapy in patients with Chagas heart disease (CHD).
Background CHD is characterized by a high burden of ventricular arrhythmias and an increased risk of sudden cardiac death. The indications for ICD are not well established.
Methods An extensive literature search without language restrictions was performed to identify all studies on ICD therapy in patients with CHD. A random effects model was used to calculate percentages and 95% confidence intervals (CIs).
Results Of 397 articles screened, 13 studies (all observational) were included. There were 1,041 patients (mean age at implantation 57 ± 11 years; 64% men), most of whom (92%) received an ICD for secondary prevention. Antiarrhythmic medication consisted of amiodarone (79%) and beta-blockers (44%). Overall, the annual all-cause mortality rate was 9.0% (95% CI: 6.9 to 11.7) in 2.8 ± 1.9 years of follow-up, and the annual sudden cardiac death rate was 2.0% (95% CI: 1.3 to 3.3) in 2.6 ± 1.9 years. In addition, 24.8% (95% CI: 15.7 to 37.0) of patients received 1 or more appropriate interventions (shocks or antitachycardia pacing), 4.7% (95% CI: 3.2 to 6.9) received inappropriate shocks, and 9.1% (95% CI: 5.5 to 14.7) had electric storms annually.
Conclusions In patients with an ICD, annual all-cause mortality rate was 9%. Appropriate ICD interventions and electric storms were frequent, occurring at a rate of 25% and 9% per year, respectively. Inappropriate ICD shocks were not infrequent (5% per year). The benefits and risks of ICD therapy in patients with CHD should be carefully weighed until data from better studies become available.
- Chagas disease
- Chagas heart disease
- implantable cardioverter-defibrillator
- systematic review
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 11, 2019.
- Revision received July 2, 2019.
- Accepted July 3, 2019.
- 2019 American College of Cardiology Foundation
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