Barbosa Lucas M, Oliveira Vinícius Martins Rodrigues, Queiroz Ivo, Portilho Natanael de Paula, Furtado William Jakymiu, Rodrigues Natasha Maranhão Vieira, Guedes Karoline Moraes, Araújo Beatriz, Itaya Eduardo Dan, Chagas Kauê Abreu, Faria Hilária Saugo, Hespanhol Larissa C, Machado Fabrício Pelucci, Fischer-Bacca Caroline de Oliveira, Nunes Maria do Carmo P
Federal University of Minas Gerais, R. Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, Brazil.
Federal University of Goiás, Goiânia, Brazil.
J Interv Card Electrophysiol. 2025 Sep 9. doi: 10.1007/s10840-025-02109-5.
Chagas heart disease (ChD) is a significant public health concern in Latin America, contributing to a high incidence of sudden cardiac death (SCD). Despite advances in heart failure treatment, management of Chagas cardiomyopathy has not progressed accordingly. While ICDs are effective for primary and secondary prevention in other conditions, patients with ChD often experience more frequent episodes of ventricular tachycardia, and ICD use may provide a negative impact and increase mortality. This meta-analysis focuses on ICD use in ChD patients, providing a comparative analysis with other etiologies.
We systematically searched PubMed, Embase, and Cochrane databases for studies evaluating ICD use in ChD. We pooled event prevalence for single-arm analyses and calculated risk ratios (RR) for pairwise comparisons with non-ChD, using a random effects model with 95% confidence intervals (CI). Statistical analyses were conducted using R version 4.4.3.
Twenty-three studies were included, comprising a pooled population of 2833 patients, with 1679 (59.2%) diagnosed with ChD. The ACM rate was 22.59% (95% CI 17.09 to 29.25). Notably, the appropriate intervention rate was 58.50% (95% CI 50.06 to 66.29), with ChD patients showing a higher incidence compared to non-ChD (RR 1.61; 95% CI 1.13 to 2.29; p < 0.01; I2 = 63%). Inappropriate therapy occurred in 7.64% (95% CI 4.98 to 11.54) of cases, while electrical storms were reported in 23.49% (95% CI 13.88 to 36.89) of ChD patients.
Overall, although ICDs can be a viable option that offers therapeutic benefits, their use in ChD patients requires careful evaluation to optimize clinical outcomes.
恰加斯心脏病（ChD）是拉丁美洲一个重大的公共卫生问题，导致心脏性猝死（SCD）的高发病率。尽管心力衰竭治疗取得了进展，但恰加斯心肌病的管理并未相应地取得进展。虽然植入式心脏复律除颤器（ICD）在其他情况下对一级和二级预防有效，但ChD患者经常经历更频繁的室性心动过速发作，使用ICD可能会产生负面影响并增加死亡率。这项荟萃分析聚焦于ChD患者使用ICD的情况，与其他病因进行比较分析。
我们系统地检索了PubMed、Embase和Cochrane数据库，以查找评估ChD患者使用ICD的研究。我们汇总了单臂分析的事件患病率，并使用具有95%置信区间（CI）的随机效应模型计算与非ChD进行成对比较的风险比（RR）。使用R版本4.4.3进行统计分析。
纳入了23项研究，共2833例患者，其中1679例（59.2%）被诊断为ChD。恰当干预率为22.59%（95%CI 17.09至29.25）。值得注意的是，恰当干预率为58.50%（95%CI 50.06至66.29），ChD患者的发生率高于非ChD患者（RR 1.61；95%CI 1.13至2.29；p＜0.01；I2 = 63%）。7.64%（95%CI 4.98至11.54）的病例发生了不恰当治疗，而23.49%（95%CI 13.88至36.89）的ChD患者报告发生了电风暴。
总体而言，尽管ICD可能是一种可行的选择并具有治疗益处，但在ChD患者中使用时需要仔细评估以优化临床结果。
