Systematic Review and Meta-Analysis of Clinical Outcome After Implantable Cardioverter-Defibrillator Therapy in Patients With Chagas Heart Disease

Rassi, Fabio Mahamed; Minohara, Lucas; Rassi, Anis; Correia, Luís Cláudio Lemos; Marin-Neto, José Antônio; Menezes, Antônio da Silva

doi:10.1016/j.jacep.2019.07.003

Cited by 21 publications

(27 citation statements)

References 30 publications

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“…In patients with CHD, ventricular tachyarrhythmias have longer cycle lengths than in patients with IHD, which is why they have a better tolerance to these arrhythmias 18 . In addition, in previous registries of ICD carrier patients with CHD, nearly 76% of ventricular tachyarrhythmia episodes were observed to be effectively interrupted with ATP; however, a non-negligible percentage of events culminate with appropriate ICD shocks, as observed in our series 19,20 .…”

Section: Discussionmentioning

confidence: 42%

First appropriate implantable defibrillator shocks in patients with Chagasic heart disease

García-Chamorro¹,

Zaidel²,

Gheco³

et al. 2022

ACME

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Objectives:The objectives of the study were to assess if patients with Chagas heart disease (CHD) received appropriate automatic implantable defibrillator (AID) shocks earlier than patients with ischemic heart disease (IHD). Methods: Analysis of a retrospective cohort of patients with CHD and IHD who received an implantable cardioverter defibrillator (ICD) between 2009 and 2018, in a tertiary hospital. We evaluated the time between the implant of ICD and the first appropriate shock in patients with CHD and compared it with the IHD control population. Results: we included a total of 64 patients, 20 with CHD and 44 with IHD. CHD patients presented earlier an appropriate shock than patients with IHD during the 1 st year (hazard ratio [HR]: 8.4; 95% confidence interval [95%CI]: 2.09-34.02; p = 0.0027), and at 3 years (HR: 4.61; p = 0.0072). About 100% of CHD patients who received the ICD as secondary prevention of sudden cardiac death presented an appropriate shock during the first 26 months of follow-up. Conclusions: Patients with CHD received appropriate ICD shocks earlier than the IHD patients. All patients with CHD and ICD as secondary prevention had an appropriate ICD shock at short term, representing the highest risk population, and supporting the indication of the device in a setting where randomized clinical trials are lacking.

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Section: Discussionmentioning

confidence: 42%

First appropriate implantable defibrillator shocks in patients with Chagasic heart disease

García-Chamorro¹,

Zaidel²,

Gheco³

et al. 2022

ACME

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“…En los pacientes con CCh, las taquiarritmias ventriculares tienen longitudes de ciclos más prolongadas que en los pacientes con CI, por lo cual presentan mejor tolerancia a dichas arritmias 18 . Además, en registros previos de pacientes con CCh portadores de DAI se observó que cerca del 76% de los episodios de taquiarritmias ventriculares pueden interrumpirse con ATP de manera efectiva; sin embargo, un porcentaje no despreciable de eventos culminan con choques apropiados del DAI, como se observó en nuestra serie 19,20 .…”

Section: Discussionunclassified

Primer choque apropiado del desfibrilador automático implantable en pacientes con cardiopatía chagásica

García-Chamorro¹,

Zaidel²,

Gheco³

et al. 2021

ACM

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Objetivos: Determinar si los pacientes con cardiopatía chagásica (CCh) presentaron choques apropiados del desfibrilador automático implantable (DAI) de manera más precoz que los pacientes con cardiopatía isquémica (CI). Métodos: Estudio de cohorte retrospectivo que incluyó los pacientes con CCh y CI en quienes se implantó un DAI entre los años 2009 y 2018 en un hospital de alta complejidad. El seguimiento se realizó hasta los 36 meses, evaluándose el momento del primer choque apropiado del dispositivo. Resultados: Se incluyeron 64 pacientes, 20 con CCh y 44 con CI. Se observó que una mayor proporción de pacientes con CCh presentaron choques apropiados durante el primer año (hazard ratio [HR]: 8.4; intervalo de confianza del 95% [IC95%]: 2.09-34.02; p = 0.0027) y a 3 años (HR: 4.61; IC95%: 1.51-14.07; p = 0.0072). El 100% de la población con CCh e implante del DAI como prevención secundaria de muerte súbita presentaron choques apropiados durante los primeros 26 meses de seguimiento. Conclusiones: Los pacientes con CCh presentaron choques apropiados del DAI de manera más precoz que los pacientes con CI. Todos los pacientes con CCh y DAI como prevención secundaria presentaron choques apropiados, representando una población de mayor riesgo. Esta información apoya la indicación del DAI en estos pacientes a pesar de la escasa evidencia en ensayos aleatorizados.

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“…Additionally, appropriate interventions (either shocks or ATP) had a rate of 25% per year. However, inappropriate shocks were not infrequent (5% per year) [ 130 ]. The CHAGASICS trial, a study designed to evaluate the benefit of ICD in patients with advanced Ch-CMP, will soon begin recruitment; thus, although promising, the evidence is yet scarce regarding the role of ICD in patients with cardiac involvement due to Chagas disease [ 131 ].…”

Section: Current Treatment and Prognosismentioning

confidence: 99%

Chagas Cardiomyopathy: From Romaña Sign to Heart Failure and Sudden Cardiac Death

et al. 2021

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Despite nearly a century of research and accounting for the highest disease burden of any parasitic disease in the Western Hemisphere, Chagas disease (CD) is still a challenging diagnosis, primarily due to its poor recognition outside of Latin America. Although initially considered endemic to Central and South America, globalization, urbanization, and increased migration have spread the disease worldwide in the last few years, making it a significant public health threat. The international medical community’s apparent lack of interest in this disease that was previously thought to be geographically restricted has delayed research on the complex host–parasite relationship that determines myocardial involvement and its differential behavior from other forms of cardiomyopathy, particularly regarding treatment strategies. Multiple cellular and molecular mechanisms that contribute to degenerative, inflammatory, and fibrotic myocardial responses have been identified and warrant further research to expand the therapeutic arsenal and impact the high burden attributed to CD. Altogether, cardiac dysautonomia, microvascular disturbances, parasite-mediated myocardial damage, and chronic immune-mediated injury are responsible for the disease’s clinical manifestations, ranging from asymptomatic disease to severe cardiac and gastrointestinal involvement. It is crucial for healthcare workers to better understand CD transmission and disease dynamics, including its behavior on both its acute and chronic phases, to make adequate and evidence-based decisions regarding the disease. This review aims to summarize the most recent information on the epidemiology, pathogenesis, clinical presentation, diagnosis, screening, and treatment of CD, emphasizing on Chagasic cardiomyopathy’s (Ch-CMP) clinical presentation and pathobiological mechanisms leading to sudden cardiac death.

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Systematic Review and Meta-Analysis of Clinical Outcome After Implantable Cardioverter-Defibrillator Therapy in Patients With Chagas Heart Disease

Cited by 21 publications

References 30 publications

First appropriate implantable defibrillator shocks in patients with Chagasic heart disease

First appropriate implantable defibrillator shocks in patients with Chagasic heart disease

Primer choque apropiado del desfibrilador automático implantable en pacientes con cardiopatía chagásica

Chagas Cardiomyopathy: From Romaña Sign to Heart Failure and Sudden Cardiac Death

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