Background: Chagas disease (CD) is a neglected chronic condition caused by Trypanosoma cruzi that has a high prevalence and causes significant morbidity in Latin America. Up to 30% of chronically infected patients develop cardiac manifestations. Ventricular arrhythmias are common in patients with Chagas cardiomyopathy and amiodarone has been widely used to reduce cardiac mortality.
Objective: To assess the effect of amiodarone in patients with a cardiac form of Chagas disease.
Methods: We searched the following electronic databases (from inception to December 2016): MEDLINE (PubMed), EMBASE and LILACS. We included both randomised and observational studies evaluating the use of amiodarone, compared to placebo or no treatment, in patients with arrhythmia and Chagas cardiomyopathy. Two reviewers independently selected studies, extracted data and assessed risk of bias. No language restriction was applied. Overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Individual patient data (IPD) meta-analysis was performed with R software, using Poisson and binomial distributions.
Results: We screened 378 titles and abstracts and included 3 before-and-after studies with a total of 52 patients. Two studies with a total of 38 patients included full dataset, allowing IPD analysis. Amiodarone reduced ventricular tachycardia in 99.9% (95%IC 99,8%-100% in 24-hour Holter monitoring), ventricular premature beats in 93,1% (IC 82%-97,4% in 24-hour Holter monitoring) and incidence of ventricular couplets in 79% (RR 4.75 (IC 2,56-8,79% in 24-hour Holter monitoring). An additional study with 14 patients reduced ventricular premature beats in 73.2%. Overall quality of evidence for reduced arrhythmias is moderate due to the large effect observed. Sinus bradycardia was found in 14 of 52 patients.
Conclusions: Although there is moderate certainty of its effect on ventricular arrhythmias, the quality of the evidence on the effect of amiodarone on mortality and cardiac arrest in Chagas disease is very low. PROSPERO: CRD42017056765