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

Marco Paulo Tomaz Barbosa, Manoel Otávio Da Costa Rocha, Alexandre Barbosa De Oliveira, Federico Lombardi, Antonio Luiz Pinho Ribeiro

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

AimsImplantable cardioverter-defibrillators (ICDs) are now a first-line option for prevention of sudden death in Chagas disease (ChD). However, efficacy and safety of ICD treatment in ChD remains controversial. The aim of our study was to compare clinical outcome after ICD implantation in ChD and non-ChD patients.Methods and resultsThe study population consists of patients who received ICD implantation in a tertiary Reference Center for ChD in Brazil. The primary endpoint of the study was appropriate therapy (appropriate shocks or anti-tachycardia pacing); the secondary endpoint was the event-free survival defined as absence of death or appropriate therapy. Three hundred thirty-five patients were followed for the median time of 266 days. Sixty-five patients had ChD. Appropriate ICD therapy occurred in 32 (49.2%) ChD and in 19 (27.1%) non-ChD patients (P=0.005). Ventricular tachycardia occurred in 27 (42%) ChD and in 16 (23%) non-ChD (P = 0.01) patients. There was a statistically significant difference in event-free survival between the group of patients with and without ChD (P=0.004). The median event-free survival was 230 days (95% confidence interval, CI: 113-347) in patients with ChD and 549 days (95% CI: 412-687) in non-ChD patients. Chagas disease double the risk of the patient to have appropriate therapy (hazard ratio, HR = 2.2, 95% CI = 1.2-4.3, P = 0.02) and appropriate therapy or death (HR = 2.2, 95% CI = 1.2-4.2, P = 0.01) in multivariate analysis. There were 16 deaths (11.8%) with 8 deaths in each group and five inappropriate shocks (3.7%) with one in ChD patients (1.6%).ConclusionThe 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.

Original languageEnglish
Pages (from-to)957-962
Number of pages6
JournalEuropace
Volume15
Issue number7
DOIs
Publication statusPublished - Jul 2013

Fingerprint

Chagas Disease
Implantable Defibrillators
Safety
Disease-Free Survival
Therapeutics
Convulsive Therapy
Defibrillators
Ventricular Tachycardia
Sudden Death
Cardiomyopathies
Tachycardia
Brazil
Shock
Multivariate Analysis
Confidence Intervals

Keywords

  • Chagas disease
  • Implantable cardioverter defibrillator
  • Sudden death
  • Ventricular arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Barbosa, M. P. T., Da Costa Rocha, M. O., De Oliveira, A. B., Lombardi, F., & Ribeiro, A. L. P. (2013). Efficacy and safety of implantable cardioverter-defibrillators in patients with Chagas disease. Europace, 15(7), 957-962. https://doi.org/10.1093/europace/eut011

Efficacy and safety of implantable cardioverter-defibrillators in patients with Chagas disease. / Barbosa, Marco Paulo Tomaz; Da Costa Rocha, Manoel Otávio; De Oliveira, Alexandre Barbosa; Lombardi, Federico; Ribeiro, Antonio Luiz Pinho.

In: Europace, Vol. 15, No. 7, 07.2013, p. 957-962.

Research output: Contribution to journalArticle

Barbosa, MPT, Da Costa Rocha, MO, De Oliveira, AB, Lombardi, F & Ribeiro, ALP 2013, 'Efficacy and safety of implantable cardioverter-defibrillators in patients with Chagas disease', Europace, vol. 15, no. 7, pp. 957-962. https://doi.org/10.1093/europace/eut011
Barbosa, Marco Paulo Tomaz ; Da Costa Rocha, Manoel Otávio ; De Oliveira, Alexandre Barbosa ; Lombardi, Federico ; Ribeiro, Antonio Luiz Pinho. / Efficacy and safety of implantable cardioverter-defibrillators in patients with Chagas disease. In: Europace. 2013 ; Vol. 15, No. 7. pp. 957-962.
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abstract = "AimsImplantable cardioverter-defibrillators (ICDs) are now a first-line option for prevention of sudden death in Chagas disease (ChD). However, efficacy and safety of ICD treatment in ChD remains controversial. The aim of our study was to compare clinical outcome after ICD implantation in ChD and non-ChD patients.Methods and resultsThe study population consists of patients who received ICD implantation in a tertiary Reference Center for ChD in Brazil. The primary endpoint of the study was appropriate therapy (appropriate shocks or anti-tachycardia pacing); the secondary endpoint was the event-free survival defined as absence of death or appropriate therapy. Three hundred thirty-five patients were followed for the median time of 266 days. Sixty-five patients had ChD. Appropriate ICD therapy occurred in 32 (49.2{\%}) ChD and in 19 (27.1{\%}) non-ChD patients (P=0.005). Ventricular tachycardia occurred in 27 (42{\%}) ChD and in 16 (23{\%}) non-ChD (P = 0.01) patients. There was a statistically significant difference in event-free survival between the group of patients with and without ChD (P=0.004). The median event-free survival was 230 days (95{\%} confidence interval, CI: 113-347) in patients with ChD and 549 days (95{\%} CI: 412-687) in non-ChD patients. Chagas disease double the risk of the patient to have appropriate therapy (hazard ratio, HR = 2.2, 95{\%} CI = 1.2-4.3, P = 0.02) and appropriate therapy or death (HR = 2.2, 95{\%} CI = 1.2-4.2, P = 0.01) in multivariate analysis. There were 16 deaths (11.8{\%}) with 8 deaths in each group and five inappropriate shocks (3.7{\%}) with one in ChD patients (1.6{\%}).ConclusionThe 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.",
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N2 - AimsImplantable cardioverter-defibrillators (ICDs) are now a first-line option for prevention of sudden death in Chagas disease (ChD). However, efficacy and safety of ICD treatment in ChD remains controversial. The aim of our study was to compare clinical outcome after ICD implantation in ChD and non-ChD patients.Methods and resultsThe study population consists of patients who received ICD implantation in a tertiary Reference Center for ChD in Brazil. The primary endpoint of the study was appropriate therapy (appropriate shocks or anti-tachycardia pacing); the secondary endpoint was the event-free survival defined as absence of death or appropriate therapy. Three hundred thirty-five patients were followed for the median time of 266 days. Sixty-five patients had ChD. Appropriate ICD therapy occurred in 32 (49.2%) ChD and in 19 (27.1%) non-ChD patients (P=0.005). Ventricular tachycardia occurred in 27 (42%) ChD and in 16 (23%) non-ChD (P = 0.01) patients. There was a statistically significant difference in event-free survival between the group of patients with and without ChD (P=0.004). The median event-free survival was 230 days (95% confidence interval, CI: 113-347) in patients with ChD and 549 days (95% CI: 412-687) in non-ChD patients. Chagas disease double the risk of the patient to have appropriate therapy (hazard ratio, HR = 2.2, 95% CI = 1.2-4.3, P = 0.02) and appropriate therapy or death (HR = 2.2, 95% CI = 1.2-4.2, P = 0.01) in multivariate analysis. There were 16 deaths (11.8%) with 8 deaths in each group and five inappropriate shocks (3.7%) with one in ChD patients (1.6%).ConclusionThe 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.

AB - AimsImplantable cardioverter-defibrillators (ICDs) are now a first-line option for prevention of sudden death in Chagas disease (ChD). However, efficacy and safety of ICD treatment in ChD remains controversial. The aim of our study was to compare clinical outcome after ICD implantation in ChD and non-ChD patients.Methods and resultsThe study population consists of patients who received ICD implantation in a tertiary Reference Center for ChD in Brazil. The primary endpoint of the study was appropriate therapy (appropriate shocks or anti-tachycardia pacing); the secondary endpoint was the event-free survival defined as absence of death or appropriate therapy. Three hundred thirty-five patients were followed for the median time of 266 days. Sixty-five patients had ChD. Appropriate ICD therapy occurred in 32 (49.2%) ChD and in 19 (27.1%) non-ChD patients (P=0.005). Ventricular tachycardia occurred in 27 (42%) ChD and in 16 (23%) non-ChD (P = 0.01) patients. There was a statistically significant difference in event-free survival between the group of patients with and without ChD (P=0.004). The median event-free survival was 230 days (95% confidence interval, CI: 113-347) in patients with ChD and 549 days (95% CI: 412-687) in non-ChD patients. Chagas disease double the risk of the patient to have appropriate therapy (hazard ratio, HR = 2.2, 95% CI = 1.2-4.3, P = 0.02) and appropriate therapy or death (HR = 2.2, 95% CI = 1.2-4.2, P = 0.01) in multivariate analysis. There were 16 deaths (11.8%) with 8 deaths in each group and five inappropriate shocks (3.7%) with one in ChD patients (1.6%).ConclusionThe 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.

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