Evaluation of patients with implantable cardioverter‐defibrillator in a Latin American tertiary center

• Published in: Journal of cardiovascular electrophysiology Vol. 35; no. 4; pp. 675 - 684
• Main Authors: França, Anna Terra, Martins, Larissa Natany Almeida, Oliveira, Derick Matheus, Castilho, Fábio Morato, Branco, Beatriz Castello, Wilnes, Bruno, Ribeiro, Antônio Luiz P., Carmo, André Assis Lopes do
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-04-2024
• Subjects: Arrhythmia; chagas cardiomyopathy; Chagas disease; Death; Defibrillators; implantable; Medical prognosis; Mortality; Public health; Tachycardia; Ventricle; ventricular; mortality; chagas cardiomyopathy; implantable; tachycardia; defibrillators; ventricular
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.16201

Introduction
Despite advancements in implantable cardioverter‐defibrillator (ICD) technology, sudden cardiac death (SCD) remains a persistent public health concern. Chagas disease (ChD), prevalent in Brazil, is associated with increased ventricular tachycardia (VT) and ventricular fibrillation (VF) events and SCD compared to other cardiomyopathies.
Methods
This retrospective observational study included patients who received ICDs between October 2007 and December 2018. The study aims to assess whether mortality and VT/VF events decreased in patients who received ICDs during different time periods (2007–2010, 2011–2014, and 2015–2018). Additionally, it seeks to compare the prognosis of ChD patients with non‐ChD patients. Time periods were chosen based on the establishment of the Arrhythmia Service in 2011. The primary outcome was overall mortality, assessed across the entire sample and the three periods. Secondary outcomes included VT/VF events and the combined outcome of death or VT/VF.
Results
Of the 885 patients included, 31% had ChD. Among them, 28% died, 14% had VT/VF events, and 37% experienced death and/or VT/VF. Analysis revealed that period 3 (2015–2018) was associated with better death‐free survival (p = .007). ChD was the only variable associated with a higher rate of VT/VF events (p < .001) and the combined outcome (p = .009).
Conclusion
Mortality and combined outcome rates decreased gradually for ICD patients during the periods 2011–2014 and 2015–2018 compared to the initial period (2007–2010). ChD was associated with higher VT/VF events in ICD patients, only in the first two periods.
Progressive decline across periods in mortality rates among patients with implantable cardioverter‐defibrillator (ICD). Chagas disease (ChD) was associated with increased rates of ventricular tachycardia and ventricular fibrillation in ICD patients only in the initial two periods, but there was no statistical difference in the last period.