Implantable cardioverter-defibrillator in Chagas heart disease: A systematic review and meta-analysis of observational studies. (15th September 2018)

• Record Type: Journal Article
• Authors: Carmo, Andre A.L.; de Sousa, Marcos R.; Agudelo, Juan F.; Boersma, Eric; Rocha, Manoel O.C.; Ribeiro, Antonio L.P.; Morillo, Carlos A.
• Is Part Of: International journal of cardiology. Volume 267(2018)
• Page Start: 88
• Page End: 93
• Publication Date: 2018-09-15
• Subjects: ICD implantable cardioverter-defibrillator -- ChCM Chagas cardiomyopathy -- RCT randomized clinical trial; Chagas heart failure -- Implantable cardioverter-defibrillator -- Ventricular tachycardia -- Amiodarone -- Antiarrhythmic drugs; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.05.091
• Languages: English
• ISSNs: 0167-5273

Abstract

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. Highlights: Efficacy of ICD for secondary prevention in ChCM is limited. There is no RCT comparing efficacy of ICD versus medical treatment in ChCM. Six observational studies were included in this meta-analysis. ICD therapy was not associated with lower rate of all-cause mortality.