Fabio Mahamed Rassi1, Lucas Minohara2, Anis Rassi6, Luis Claudio Lemos Correia4, José Antonio Marin-Neto5, Anis Rassi6, Antonio da Silva Menezes2. 1. Hospital do Coração Anis Rassi, Goiânia, Brazil; Pontifícia Universidade Católica de Goiás, Escola de Ciências Médicas, Farmacêuticas e Biomédicas, Goiânia, Brazil. 2. Pontifícia Universidade Católica de Goiás, Escola de Ciências Médicas, Farmacêuticas e Biomédicas, Goiânia, Brazil. 3. Hospital do Coração Anis Rassi, Goiânia, Brazil. Electronic address: arassijr@terra.com.br. 4. Medical and Public Health School of Bahia, Salvador, Brazil. 5. Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil. 6. Hospital do Coração Anis Rassi, Goiânia, Brazil.
Abstract
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.
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.
Authors: Antonia Pino-Marín; Germán José Medina-Rincón; Sebastian Gallo-Bernal; Alejandro Duran-Crane; Álvaro Ignacio Arango Duque; María Juliana Rodríguez; Ramón Medina-Mur; Frida T Manrique; Julian F Forero; Hector M Medina Journal: Pathogens Date: 2021-04-22