Clinical Course After Cardioverter-Defibrillator Implantation: Chagasic Versus Ischemic Patients

Abstract

Background:The outcome of Chagas disease patients after receiving implantable cardioverter defibrillator (ICD) is still controversial.Objective:To compare clinical outcomes after ICD implantation in patients with chronic Chagas cardiomyopathy (CCC) and ischemic heart disease (IHD).Methods:Prospective study of a population of 153 patients receiving ICD (65 with CCC and 88 with IHD). The devices were implanted between 2003 and 2011. Survival rates and event-free survival were compared.Results:The groups were similar regarding sex, functional class and ejection fraction. Ischemic patients were, on average, 10 years older than CCC patients (p < 0.05). Patients with CCC had lower schooling and monthly income than IHD patients (p < 0.05). The number of appropriate therapies was 2.07 higher in CCC patients, who had a greater incidence of appropriate shock (p < 0.05). Annual mortality rate and electrical storm incidence were similar in both groups. There was no sudden death in CCC patients, and only one in IHD patients. Neither survival time (p = 0.720) nor event-free survival (p = 0.143) significantly differed between the groups.Conclusion:CCC doubles the risk of receiving appropriate therapies as compared to IHD, showing the greater complexity of arrhythmias in Chagas patients.

Hospitalization for Chagas Heart Disease in the United States From 2002 to 2017

“…Arrhythmias are common in Chagas heart disease . This was evident in our study, as 27.1% of discharges had atrial tachyarrhythmias and 25.0% of discharges had ventricular tachyarrhythmias.…”

“…Arrhythmias are common in Chagas heart disease. 6 This was evident in our study, as 27.1% of discharges had atrial tachyarrhythmias and 25.0% of discharges had ventricular tachyarrhythmias. Device management was common, as 2.5% of discharges had pacemaker placement and nearly 11% of discharges had an implantable cardiac defibrillator placed.…”

First appropriate implantable defibrillator shocks in patients with Chagasic heart disease

“…Our findings clearly show that, during follow-up, patients with CHD had appropriate shocks of the device in a higher percentage and earlier (on average 9.7 months earlier) than the subjects with IHD. This behavior by patients with CHD of having ICD shocks more prematurely had already been described 12 , a trend that would be clearly influenced by the substrate produced by the disease on the myocardium, since, as observed in our analysis, the population with IHD exhibits a higher proportion of factors traditionally associated with an increase in the probability of having appropriate ICD shocks (lower left ventricular ejection fraction and less use of antiarrhythmic drugs) 13 . Interestingly, the entire population with CHD and ICD implantation as sudden cardiac death secondary prevention had appropriate shocks during the first 26 months of follow-up, representing the group at highest risk for receiving therapies by the device, a behavior that had also been observed in previous series 14,15 , in which this population had twice the risk of having effective ICD discharges, in comparison with patients with heart disease of other etiologies 8 .…”

Primer choque apropiado del desfibrilador automático implantable en pacientes con cardiopatía chagásica

“…En nuestros hallazgos destaca que, durante el seguimiento, los pacientes con CCh presentaron en mayor porcentaje y de manera más precoz choques apropiados del dispositivo (en promedio 9.7 meses antes) que los sujetos con CI. Este comportamiento por parte de los pacientes con CCh de presentar choques del DAI de manera más prematura ya había sido descrito 12 , tendencia que estaría claramente influenciada por el sustrato producido por la enfermedad sobre el miocardio, ya que, como se observó en nuestro análisis, la población con CI presenta en mayor proporción factores que tradicionalmente se asocian a un aumento de la probabilidad de presentar choques apropiados del DAI (menor fracción de eyección del ventrículo izquierdo y menor uso de fármacos antiarrítmicos) 13 . Llama la atención que el total de la población con CCh e implante de DAI como prevención secundaria de muerte súbita presentó choques apropiados durante los primeros 26 meses de seguimiento, representando el grupo de mayor riesgo para recibir terapias por parte del dispositivo; comportamiento que también había sido observado en series previas 14,15 , en las que esta población tenía el doble de riesgo de presentar descargas efectivas del DAI en comparación con los pacientes con cardiopatías de otras etiologías 8 .…”