Medline ® Abstract for Reference 30
of 'Chagas heart disease: Treatment and prognosis'
Implantable cardioverter-defibrillators for treatment of sustained ventricular arrhythmias in patients with Chagas' heart disease: comparison with a control group treated with amiodarone alone.
Gali WL, Sarabanda AV, Baggio JM, Ferreira LG, Gomes GG, Marin-Neto JA, Junqueira LF
AIMS: Evidence is inconclusive concerning the benefit of implantable cardioverter-defibrillators (ICDs) for secondary prevention of mortality in patients with Chagas' heart disease (ChHD). The aim of this study was to compare the outcomes of ChHD patients with life-threatening ventricular arrhythmias (VAs), who were treated either with ICD implantation plus amiodarone or with amiodarone alone.
METHODS AND RESULTS: The ICD group [76 patients; 48 men; age, 57±11 years; left ventricular ejection fraction (LVEF), 39±12%]and the historical control group treated with amiodarone alone (28 patients; 18 men; age, 54±10 years; LVEF, 41±10%) had comparable baseline characteristics, except for a higher use of beta-blockers in the ICD group (P<0.0001). Amiodarone was also used in 90% of the ICD group. Therapy with ICD plus amiodarone resulted in a 72% reduced risk of all-cause mortality (P = 0.007) and a 95% reduced risk of sudden death (P = 0.006) compared with amiodarone-only therapy. The survival benefit of ICDwas greatest in patients with LVEF<40% (P = 0.01) and was not significant in those with LVEF≥40% (P = 0.15). Appropriate ICD therapies occurred in 72% of patients and the rates of interventions were similar across patients with LVEF<40% and≥40%.
CONCLUSION: Compared with amiodarone-only therapy, ICD implantation plus amiodarone reduced the risk of all-cause mortality and sudden death in ChHD patients with life-threatening VAs. Patients with LVEF<40% derived significantly more survival benefit from ICD therapy. The majority of ICD-treated patients received appropriate therapies regardless of the LV systolic function.
Clinical Arrhythmia and Pacemaker Unit, Instituto de Cardiologia do Distrito Federal (IC-DF), Fundação Universitária de Cardiologia (FUC), AOS 02 Bloco B apto 604, Brasília, 70660-022 DF, Brazil.