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Int J Cardiol. 2018 Sep 15;267:88-93. doi: 10.1016/j.ijcard.2018.05.091. Epub 2018 May 29.

Implantable cardioverter-defibrillator in Chagas heart disease: A systematic review and meta-analysis of observational studies.

Author information

1
Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Minas Gerais, Brazil.
2
Arrhythmia & Electrophysiology Service, Hospital San Vicente de Paul, Medellin, Colombia.
3
Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands.
4
Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Minas Gerais, Brazil. Electronic address: tom@hc.ufmg.br.
5
Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.

Abstract

BACKGROUND:

In patients with Chagas cardiomyopathy (ChCM), sudden cardiac death (SCD) is the leading cause of mortality. Implantable cardioverter-defibrillator (ICD) is a well-established therapy for secondary prevention in patients with structural heart disease, but there are conflicting opinions regarding its efficacy and safety in patients with ChCM. The aim of this meta-analysis was to assess the efficacy of the ICD for secondary prevention in patients with ChCM, comparing mortality as the primary outcome of patients treated with ICD with those treated with amiodarone.

METHODS:

We systematically searched five databases for studies assessing mortality outcomes in patients with ChCM and sustained ventricular tachycardia (VT) treated with ICD implantation or with amiodarone. The results of studies were pooled using random-effects modeling.

RESULTS:

There was no randomized clinical trial comparing efficacy of ICD versus medical treatment in patients with ChCM. Six observational studies were included, totalizing 115 patients in amiodarone group and 483 patients in ICD group. The mortality outcome in the ICD population was 9.7 per 100 patient-years of follow-up (95%CI 5.7-13.7) and 9.6 per 100 patient-years in the amiodarone group (95%CI 6.7-12.4) (p = 0.95). Meta-regression did not show any association with LV ejection fraction (p = 0.32), age (p = 0.44), beta-blocker (p = 0.33) or angiotensin-converting enzyme inhibitors (p = 0.096) usage.

CONCLUSION:

The best available evidence derived from small observational studies suggests that ICD therapy in secondary prevention of sudden death (VT or resuscitated SCD) is not associated with lower rate of all-cause mortality in patients with ChCM. Randomized controlled trials are needed to answer this question.

KEYWORDS:

Amiodarone; Antiarrhythmic drugs; Chagas heart failure; Implantable cardioverter-defibrillator; Ventricular tachycardia

PMID:
29871807
DOI:
10.1016/j.ijcard.2018.05.091
[Indexed for MEDLINE]

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