Long-term follow-up of patients with chronic chagas disease and implantable cardioverter-defibrillator.
OBJECTIVE
Chronic Chagas heart disease (ChHD) is associated with ventricular tachyarrhythmias and an increased risk of sudden cardiac death. Little is known about the effectiveness of implantable cardioverter-defibrillator (ICD) therapy in this population. The objective of this study was to evaluate the efficacy of ICD in patients with ChHD and to identify predictors of mortality and appropriate ICD shocks.


METHODS
The cohort study included 65 patients with ChHD and ICD for primary and secondary prevention of sudden death. The Cox model was applied to evaluate the predictors of mortality, and survival was assessed by Kaplan-Meier analysis.


RESULTS
The median age was 56 ± 11.9 years. The median follow-up was 40 ± 26.8 months. Among the patients 23 (36.5%) had appropriate shocks. A total of 13 (20%) patients died (6.1% of annual mortality rate), and there was no sudden death. In univariate Cox model, functional class IV (hazard ratio [HR] = 1.99; 95% confidence interval [CI], 1.05-3.76; P = 0.034), primary prevention (HR = 0.29; 95% CI, 0.09-0.99; P = 0.048), lower education (HR = 2.51; 95% CI, 1.05-5.99; P = 0.038), and ejection fraction <30% (HR = 2.80; 95% CI, 1.09-7.18; P = 0.032) were predictors of worse prognosis (death). In the multivariate Cox model, an ejection fraction <30% and the low education remained predictors of poor prognosis. Predictors of appropriate shocks were not found.


CONCLUSIONS
The ICD was effective for the prevention of sudden cardiac death in patients with chronic ChHD. An ejection fraction <30% and low education were predictors of poor prognosis.
Department of Community Health, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Division of Pacemaker and Electrophisiology, Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, Ceará, Brazil.
Francisca Tatiana Moreira
FT
Pereira
Eduardo Arrais
EA
Rocha
Marcelo de Paula Martins
Mde P
Monteiro
Almino Cavalcante Rocha
AC
Neto
Elisabeth de Francesco
Ede F
Daher
Carlos Roberto Martins Rodrigues
CR
Sobrinho
Roberto da Justa
Rda J
Pires Neto
D001938:Brazil / Q000453:epidemiology; D002598:Chagas Cardiomyopathy / Q000401:mortality* / Q000628:therapy*; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
CRT; VT; defibrillation-ICD