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J Cardiovasc Electrophysiol. 2019 Sep 9. doi: 10.1111/jce.14164. [Epub ahead of print]

Chagas disease is associated with a worse prognosis at 1-year follow-up after implantable cardioverter-defibrillator for secondary prevention in heart failure patients.

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1
Hospital Ana Nery - Department of Medicine of the Federal University of Bahia, Brazil.

Abstract

INTRODUCTION:

There are conflicting data regarding the efficacy of implantable cardioverter-defibrillator (ICD) in Chagas' disease (CD) patients. This study aims to evaluate the short-term outcome after ICD for secondary prevention, in a population where CD is a prevalent cause of heart failure (HF).

METHODS AND RESULTS:

Consecutive patients with HF and reduced left ventricular ejection fraction (LVEF), who underwent ICD implantation for secondary prevention of sudden cardiac death. Clinical and demographic data were collected to investigate mortality predictors at 1 year. During the study period, 117 patients underwent ICD implantation, of which 108 were included. The most frequent causes of HF was CD: 52 (48.1%), and ischemic cardiomyopathy: 20 (18.5%). Chagas and non-Chagas patients were well balanced: male: 32 (61.5%) vs 38 (67.9%), p=0.548; age: 59.2 (±10.9) vs 56.8 (±13.4), p = 0.681 and LVEF 34.1 (±10.2) vs 31.3 (±8.7), p=0.064, respectively. At the mean follow-up of 15.7 months, overall mortality occurred in 14 (12.9%) patients, with a higher incidence in patients with CD cardiomyopathy, 11 (21.2%) vs 3 (5.4%), p=0.021 (log-rank). In the multivariate analysis, CD remained as an independent predictor for death (HR: 4.62, CI: 1.27-16.81, p=0.021).

CONCLUSION:

CD was associated with a poor short-term outcome in patients with HF submitted to ICD implantation for secondary prevention when compared to other HF etiologies. In this specific HF population, ICD indication should be individualized, considering the worst prognosis of these patients. This article is protected by copyright. All rights reserved.

KEYWORDS:

Chagas cardiomyopathy; Chagas disease; heart failure; implantable cardioverter-defibrillator

PMID:
31502385
DOI:
10.1111/jce.14164

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