Assessing the role of ICD in Chagas heart disease: a systematic review, meta-analysis, and meta-regression

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.