Implantable cardioverter-defibrillators for treatment of sustained ventricular arrhythmias in patients with Chagas' heart disease: comparison with a control group treated with amiodarone alone

Europace. 2014 May;16(5):674-80. doi: 10.1093/europace/eut422. Epub 2014 Jan 30.


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 ICD was 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.

Keywords: Amiodarone; Chagas' disease; Implantable cardioverter-defibrillator.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Accelerated Idioventricular Rhythm / etiology
  • Accelerated Idioventricular Rhythm / therapy*
  • Adult
  • Aged
  • Amiodarone / therapeutic use*
  • Anti-Arrhythmia Agents / therapeutic use*
  • Chagas Cardiomyopathy / complications
  • Chagas Cardiomyopathy / therapy*
  • Death, Sudden, Cardiac / etiology
  • Death, Sudden, Cardiac / prevention & control*
  • Defibrillators, Implantable*
  • Female
  • Historically Controlled Study
  • Humans
  • Male
  • Middle Aged
  • Secondary Prevention
  • Severity of Illness Index
  • Stroke Volume
  • Tachycardia, Ventricular / etiology
  • Tachycardia, Ventricular / therapy
  • Treatment Outcome
  • Ventricular Fibrillation / etiology
  • Ventricular Fibrillation / therapy*


  • Anti-Arrhythmia Agents
  • Amiodarone