Implantable Cardioverter-Defibrillators in Chagas Cardiomyopathy

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Primary-prevention implantable cardioverter-defibrillator recipients with dilated cardiomyopathy (n=194). Intervention: Chagas cardiomyopathy vs. Non-Chagas cardiomyopathy (ischaemic and non-ischaemic dilated cardiomyopathy). Primary outcome: Composite of first appropriate ICD therapy or all-cause death (HR 0.58, 95% CI 0.37-0.91, p=0.018).

Sérgio Dubner

doi:10.1001/jamacardio.2025.1273

May 28, 2025JAMA Cardiology

Implantable Cardioverter-Defibrillators in Chagas Cardiomyopathy

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Key result

Chagas cardiomyopathy is linked to ~42% lower risk of appropriate ICD therapy or death.

HR 0.58
95% CI 0.37-0.91
P=0.018
n=194

Figures

Why the study?

Does Chagas cardiomyopathy etiology alter the temporal risk of appropriate ICD therapy or death compared to non-Chagas etiologies in patients receiving an ICD for primary prevention?

Key Points

To assess long-term outcomes and the temporal pattern of composite clinical endpoints in patients receiving implantable cardioverter-defibrillators for Chagas cardiomyopathy compared with other etiologies.
Followed 194 patients receiving an implantable cardioverter-defibrillator (50 with Chagas cardiomyopathy, 83 with ischaemic cardiomyopathy, and 61 with non-ischaemic dilated cardiomyopathy) over a mean follow-up of 6.8 ± 5.7 years in the Chagas group and 5.0 ± 4.5 years in the non-Chagas group.
Evaluated a composite endpoint of appropriate ICD therapy or all-cause death using Kaplan–Meier curves, restricted mean survival time (RMST), multivariable Cox proportional hazards models, and period-specific landmark analyses.
The composite endpoint occurred in 25 of 50 Chagas patients (50.0%) and 84 of 144 non-Chagas patients (58.3%), with an overall multivariable adjusted hazard ratio of 0.58 (95% CI: 0.37–0.91; p = 0.018).
Risk differed significantly over time: Chagas etiology showed a markedly lower risk during the first 5 years (HR: 0.35; 95% CI: 0.17–0.75; p = 0.007; 58 events), but no detectable difference beyond 5 years (HR: 0.85; 95% CI: 0.47–1.54; p = 0.587; 51 events).
Over a 10-year horizon, patients with Chagas cardiomyopathy gained 682 additional event-free days (95% CI: 258–1047; p = 0.001) by restricted mean survival time analysis.

Study Design

Type

Cohort (n=194)

Multicenter

Yes

Structured PICO

Does Chagas cardiomyopathy etiology alter the temporal risk of appropriate ICD therapy or death compared to non-Chagas etiologies in patients receiving an ICD for primary prevention?

P

Population

194 consecutive patients with dilated cardiomyopathy (50 with Chagas, 144 non-Chagas) who received an ICD for primary prevention, followed for a mean of 5.5 years.

E

Exposure

Implantable cardioverter-defibrillator (ICD) placed for primary prevention in patients with Chagas cardiomyopathy.

C

Comparator

Implantable cardioverter-defibrillator (ICD) placed for primary prevention in patients with non-Chagas cardiomyopathy (ischemic or non-ischemic dilated cardiomyopathy).

O

Outcome

Composite of first appropriate ICD therapy (antitachycardia pacing or shock delivered for documented ventricular tachycardia or ventricular fibrillation) or all-cause death, whichever occurred first, adjudicated independently by two electrophysiologists via electrogram review.composite

Main Result

Hazard Ratio: 0.58 (95% CI 0.37–0.91)

Absolute Event Rate: 50% vs 58.3%

p-value: p=0.018

Limitations

Retrospective observational design precludes causal inference.
Small Chagas subgroup (n=50) limits the precision of period-specific estimates, particularly beyond five years.
Follow-up duration was significantly longer in the Chagas group.
Unmeasured variables including NYHA functional class and heart-failure therapies could not be included in the adjusted model.
Amiodarone use is subject to confounding by indication.
Cause-specific mortality was not adjudicated.
ICD programming criteria evolved across the 2008–2025 enrolment window.
Few patients were followed beyond 15 years, limiting estimates in the tail end of the survival curves.
Retrospective observational design precluding causal inference.
Small Chagas subgroup (n=50) resulting in limited precision of period-specific estimates beyond five years.
Differential follow-up duration between groups.
Missing systematic recording of NYHA functional class, detailed imaging findings, and baseline medical therapies like beta-blockers or sotalol.

Implication

Patients with Chagas cardiomyopathy receiving a primary-prevention ICD experience a delayed accumulation of arrhythmic and mortality events compared to non-Chagas etiologies, suggesting that early event-free survival does not ensure a long-term low-risk trajectory.

Abstract

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Discussion

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Cite This Study

Sérgio Dubner (2025) conducted a cohort in Primary-prevention implantable cardioverter-defibrillator recipients with dilated cardiomyopathy (n=194). Chagas cardiomyopathy vs. Non-Chagas cardiomyopathy (ischaemic and non-ischaemic dilated cardiomyopathy) was evaluated on Composite of first appropriate ICD therapy or all-cause death (HR 0.58, 95% CI 0.37-0.91, p=0.018). In primary-prevention ICD recipients, Chagas cardiomyopathy was associated with a significantly lower risk of the composite of appropriate ICD therapy or death compared to non-Chagas aetiologies (HR 0.58).

synapsesocial.com/papers/6ad2b5074c9c4fbb13a7edaf https://doi.org/10.1001/jamacardio.2025.1273

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Implantable Cardioverter-Defibrillators in Chagas Cardiomyopathy

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Implantable Cardioverter-Defibrillators in Chagas Cardiomyopathy

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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