Cardiac resynchronization therapy in chronic Chagas cardiomyopathy: A systematic review and single-arm meta-analysis

• Published in: Heart Rhythm O2
• Main Authors: Iuri Ferreira Felix, MD, Vanessa Karlinski Vizentin, MD, Mangesh Kritya, MBBS, Shanmukh Sai Pavan Lingamsetty, MBBS, Priyanshi Maurya, MBBS, Norma N. Gamarra Valverde, MD, Nicole Felix, MD, Vanio Antunes do Livramento Junior, David M. Harmon, MD, Abhishek J. Deshmukh, MBBS, Gurukripa N. Kowlgi, MBBS, Christopher V. DeSimone, MD, PhD
• Format: Article
• Language: English
• Published: Elsevier 2025-09-01
• Subjects: Cardiac resynchronization therapy; Chagas cardiomyopathy; Heart failure; Neglected diseases; Mortality
• Online Access: http://www.sciencedirect.com/science/article/pii/S2666501825002375

Background: Cardiac resynchronization therapy (CRT) is a well-established therapy for patients with heart failure. However, patients with chronic Chagas cardiomyopathy (CCC) were underrepresented in pivotal CRT trials. Objective: This systematic review and meta-analysis aim to quantitatively describe the outcomes of CRT in patients with CCC. Methods: We systematically searched PubMed, Embase, Cochrane, and LILACS registries for studies evaluating the response to CRT in patients with CCC. We applied no language or date restrictions. We applied an inverse-variance random-effects model for a meta-analysis of proportions. Results: We included 4 observational cohort studies comprising 250 patients with CCC undergoing CRT. At CRT implantation, the mean age was 59 ± 12 years, 87% of patients (217) were New York Heart Association class III/IV, and the average left ventricular ejection fraction (LVEF) was 27% ± 7%. During a mean follow-up of 30 ± 25 months, the all-cause death rate was 38% (95% confidence interval [CI], 21–56), cardiac death rate was 29% (95% CI, 13–47), and the noncardiac death rate was 4% (95% CI, 1–9). After CRT, the proportion of patients rated New York Heart Association class III/IV was improved to 21% (95% CI, 5–44), with a pooled post-CRT LVEF of 36.3% (95% CI, 27.0–48.0). Conclusion: In patients with CCC, CRT was associated with improvements in LVEF and symptomatic and functional burden (class III/IV), but overall mortality remained high. Although CRT seems to be beneficial in this population, further research is warranted to better characterize its impact on long-term clinical outcomes.