Chagas disease is a tropical disease that is neglected worldwide, contributing substantially to the burden of morbidity and mortality in populations and exerting a considerable socioeconomic effect when cardiac alterations develop (20-30% of infected individuals). [1][2][3][4][5][6] Sudden cardiac death is the most common cause of death (55-65% of patients with Chagas disease). In general, the final stage consists of malignant ventricular arrhythmia, resulting from an interaction between the anatomical substrate (fibrosis) and a functional trigger that creates areas of heterogeneous electrophysiological conduction and, consequently, cardiac electrical instability [7][8][9][10][11] In parallel, some evidence suggests that cardiac autonomic dysfunction is a relevant, intense, independent, and early phenomenon in the natural history of the disease, acting as a trigger for malignant arrhythmias and thus representing a potential marker of risk. [12][13][14][15][16][17][18][19][20] Although important prognostic factors have already been described, the stratification of risk remains a challenge. Rassi et al. proposed a simple risk score Int J Cardiovasc Sci. 2022; [online].ahead print, PP.0-0