Efficacy and safety of implantable cardioverter-defibrillators in patients with Chagas disease

Abstract

The higher frequency of appropriate ICD therapy and the shorter event-free survival in ChD patients are consistent with the presence of an arrhythmogenic substrate that characterizes this cardiomyopathy.

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

“…Najwcześniejszymi objawami są często zaburzenia przewodzenia, w tym RBBB oraz blok przedniej wiązki lewej odnogi pęczka Hisa, a później występują odcinkowe zaburzenia czynności skurczowej LV, złożona VA, dysfunkcja węzła zatokowego oraz bardziej zaawansowane zaburzenia przewodzenia. W późniejszych stadiach choroby dochodzi do postępującej rozstrzeni i dysfunkcji skurczowej LV [426][427][428][429][430]. Opisywana roczna śmiertelność wśród pacjentów z chorobą Chagasa wynosi 0,2-19,2%, co odzwierciedla zróżnicowaną charakterystykę różnych badanych populacji.…”

ICDs in Chagas heart disease: the standard treatment for secondary prevention of sudden death

“…Our results suggest secondary prevention with ICD can be more useful in patients with Chagas disease (ChD) than other cardiopathies, due to the high arrhythmogenic profile of the former. 8 Indeed, we found that ChD increased by 2.2 times the chance of patients receiving an ICD appropriate therapy and that ChD was the only independent predictor of combined outcome death or appropriate therapy in this sample. Moreover, we have previously demonstrated that Chagas cardiomyopathy was associated with poorer survival compared with idiopathic disease, 9 further suggesting that the benefit of ICD implantation could be higher in ChD than in other cardiopathies.…”

Ventricular arrhythmias in Chagas disease

“…Studies by Muratore et al (50), (51) and Fonseca et al (53) found no difference between the populations with and without Chagas disease in the numbers of arrhythmia episodes, shocks, and deaths. In contrast, the studies by Martinelli-Filho et al (44) , Rabinovich et al (51) , Moreira (49) , Cardinalli-Neto et al (54) , Cardinalli-Neto et al (55) , Barbosa et al (52) and the ICD registry for patients with Chagas disease in Latin America, published in 2009 (56) , found differences between the chagasic and non-chagasic populations. ChD groups had higher numbers of ventricular arrhythmias, a higher percentage of patients receiving appropriate therapy and increased numbers of shocks overall.…”

“…Studies of ICD implantation in patients with ChD have aimed to evaluate its effi cacy and safety and to identify predictors of appropriate therapy (47), (48) . In addition, several studies have compared the results of ICD implantation in ChD patients with the results of ICD implantation in the non-chagasic population to identify similarities and differences between these populations (44), (49)(50)(51)(52) . All of these studies investigated patients for whom ICD was indicated for the prevention of arrhythmias secondary to ChD.…”