Abstract
BackgroundChagas disease is a neglected chronic condition caused by Trypanosoma cruzi, with high prevalence and burden in Latin America. Ventricular arrhythmias are common in patients with Chagas cardiomyopathy, and amiodarone has been widely used for this purpose. The aim of our study was to assess the effect of amiodarone in patients with Chagas cardiomyopathy.MethodologyWe searched MEDLINE, Embase and LILACS up to January 2018. Data from randomized and observational studies evaluating amiodarone use in Chagas cardiomyopathy were included. Two reviewers selected the studies, extracted data and assessed risk of bias. Overall quality of evidence was accessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).Principal findingsWe included 9 studies (3 before-after studies, 5 case series and 1 randomized controlled trial). Two studies with a total of 38 patients had the full dataset, allowing individual patient data (IPD) analysis. In 24-hour Holter, amiodarone reduced the number of ventricular tachycardia episodes in 99.9% (95%CI 99.8%-100%), ventricular premature beats in 93.1% (95%CI 82%-97.4%) and the incidence of ventricular couplets in 79% (RR 0.21, 95%CI 0.11–0.39). Studies not included in the IPD analysis showed a reduction of ventricular premature beats (5 studies), ventricular tachycardia (6 studies) and ventricular couplets (1 study). We pooled the incidence of adverse side effects with random effects meta-analysis; amiodarone was associated with corneal microdeposits (61.1%, 95%CI 19.0–91.3, 5 studies), gastrointestinal events (16.1%, 95%CI 6.61–34.2, 3 studies), sinus bradycardia (12.7%, 95%CI 3.71–35.5, 6 studies), dermatological events (10.6%, 95%CI 4.77–21.9, 3 studies) and drug discontinuation (7.68%, 95%CI 4.17–13.7, 5 studies). Quality of evidence ranged from moderate to very low.ConclusionsAmiodarone is effective in reducing ventricular arrhythmias, but there is no evidence for hard endpoints (sudden death, hospitalization). Although our findings support the use of amiodarone, it is important to balance the potential benefits and harms at the individual level for decision-making.
Highlights
Chagas disease, known as American trypanosomiasis [1], is an important public health problem in Latin America, and remains a substantial cause of morbidity and mortality [2]
Amiodarone is effective in reducing ventricular arrhythmias, but there is no evidence for hard endpoints
Our findings support the use of amiodarone, it is important to balance the potential benefits and harms at the individual level for decision-making
Summary
Known as American trypanosomiasis [1], is an important public health problem in Latin America, and remains a substantial cause of morbidity and mortality [2]. Despite the lack of solid evidence-based data on Chagas disease, therapy should generally be instituted extrapolating from guidelines for the management of heart failure patients, including neurohumoral inhibition, resynchronization therapy, and implantable cardioverter defibrillator [10]. This alternative is not readily available for low income populations such as those affected by Chagas disease. The aim of our study was to assess the effect of amiodarone in patients with Chagas cardiomyopathy
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