Universidade Federal do Ceará, Fortaleza, CE - Brasil.
Universidade de Fortaleza, Fortaleza, CE - Brasil.
Arq Bras Cardiol. 2024 Aug 19;121(6):e20230337. doi: 10.36660/abc.20230337. eCollection 2024.
There are few retrospective and prospective studies on implantable cardioverter-defibrillators (ICD) in primary and secondary prevention of sudden death in chronic Chagas heart disease (CCHD).
To describe the long-term evolution of patients with CCHD and ICD and to identify and analyze predictors of mortality and appropriate device therapy in this population.
This was a historical prospective study with 117 patients with ICD and CCHD. Devices were implanted from January 2003 to December 2021. Predictors of appropriate therapies and long-term mortality were identified and analyzed. The level of statistical significance was p < 0.05.
Patients (n = 117) had a median follow-up of 61 months (25 to 121 months); they were predominantly male (74%), with a median age of 55 years (48 to 64 years). There were 43.6% appropriate shocks, 26.5% antitachycardia pacing (ATP), and 51% appropriate therapies. During follow-up, 46 patients (39.7%) died. Mortality was 6.2% person-years (95% confidence interval [CI]: 4.6 to 8.3), with 2 sudden deaths during follow-up. Secondary prevention (hazard ratio [HR] 2.1; 95% CI: 1.1 to 4.3; p = 0.029) and ejection fraction less than 30% (HR 1.8; 95% CI: 1.1 to 3.1; p < 0.05) were predictors of appropriate therapies. Intermediate Rassi score showed a strong association with the occurrence of ATP alone (p = 0.015). Functional class IV (p = 0.007), left ventricular ejection fraction < 30 (p = 0.010), and age above 75 years (p = 0.042) were predictors of total mortality.
ICDs in CCHD showed a high incidence of appropriate activation, especially in patients with secondary prevention, low left ventricular ejection fraction, and intermediate Rassi score. Patients with congestive heart failure, elevated functional class, and age over 75 years showed elevated mortality. Survival function of patients with implantable cardioverter-defibrillators and chronic Chagas heart disease. A - According to New York Heart Association functional class; B - According to left ventricular ejection fraction; C - According to Rassi score. D - According to age. CCHD: chronic Chagas heart disease; HR: hazard ratio; ICD: implantable cardioverter-defibrillator.
在原发性和继发性预防慢性恰加斯心脏病（CCHD）猝死中，关于植入式心脏复律除颤器（ICD）的回顾性和前瞻性研究较少。
描述 CCHD 和 ICD 患者的长期演变情况，并确定和分析该人群死亡率和适当设备治疗的预测因素。
这是一项历史前瞻性研究，纳入了 117 例接受 ICD 治疗的 CCHD 患者。ICD 于 2003 年 1 月至 2021 年 12 月植入。确定并分析了适当治疗和长期死亡率的预测因素。统计显著性水平为 p < 0.05。
患者（n = 117）中位随访时间为 61 个月（25 至 121 个月）；他们主要为男性（74%），中位年龄为 55 岁（48 至 64 岁）。有 43.6%的患者发生了适当的电击，26.5%发生了抗心动过速起搏（ATP），51%发生了适当的治疗。在随访期间，有 46 名患者（39.7%）死亡。死亡率为 6.2%人年（95%置信区间[CI]：4.6 至 8.3），随访期间有 2 例猝死。二级预防（风险比[HR]2.1；95%CI：1.1 至 4.3；p = 0.029）和射血分数<30%（HR 1.8；95%CI：1.1 至 3.1；p < 0.05）是适当治疗的预测因素。中危 Rassi 评分与单独发生 ATP 有很强的相关性（p = 0.015）。心功能 IV 级（p = 0.007）、左室射血分数<30（p = 0.010）和年龄>75 岁（p = 0.042）是总死亡率的预测因素。
CCHD 中的 ICD 显示出适当激活的高发生率，特别是在二级预防、左室射血分数较低和中危 Rassi 评分的患者中。充血性心力衰竭、功能分级升高和年龄>75 岁的患者死亡率升高。植入式心脏复律除颤器和慢性恰加斯心脏病患者的生存功能。A-根据纽约心脏协会功能分级；B-根据左室射血分数；C-根据 Rassi 评分；D-根据年龄。CCHD：慢性恰加斯心脏病；HR：风险比；ICD：植入式心脏复律除颤器。
