Implantable devices in chronic Chagas cardiomyopathy: outcomes and a delayed response to CRT in a real-world cohort
C Calderon Franco, D Ocampo Gomez, D Santacruz Pacheco, F Mendoza, J Rosas Andrade, C Jaramillo, A LinerosAbstract
Background
Chronic Chagas cardiomyopathy (CCC) features conduction disease, ventricular arrhythmias and progressive heart failure. Despite broad use of pacemakers, implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy (CRT), evidence in CCC remains limited.
Objective
To describe characteristics and outcomes of CCC patients with implantable cardiac devices in a Colombian referral center.
Methods
Retrospective cohort of adults (≥18 years) with confirmed CCC and a cardiac device, followed at our Clinic from 2004–2025. We captured sociodemographic, ECG/echocardiographic and device variables. Outcomes included heart-failure/arrhythmia hospitalizations, NYHA class change and mortality. Predictors of a composite endpoint (death or hospitalization) were assessed by logistic regression.
Results
Fifty patients were included (mean age 64.2 years; 42% men; rural origin). Right bundle branch block (52%), atrial fibrillation (44%), chronic kidney disease (50%) and left-ventricular apical aneurysm (34%) were common. Devices were ICD 38.7%, CRT-D 38.7%, pacemaker 18.3% and CRT-P 4.0%; CRT was used in 21 patients (42%) with high biventricular pacing (mean 96.5%). NYHA class improved after implantation, mainly among baseline NYHA III patients, and CRT response was more often documented at 12 months than at 6 months. Event-free survival appeared higher in CRT-D recipients. Worse outcomes were associated with age >65 years (OR 9.2), LVEF <30% (OR 12.2), severe mitral regurgitation (OR 2.7) and sustained ventricular tachycardia (OR 11.1).
Conclusions
CCC patients receiving devices have advanced electrical and structural disease. Device therapy—particularly CRT-D—was associated with functional improvement and a potentially delayed CRT response, highlighting the importance of careful candidate selection and follow-up in endemic settings.Kaplan Meier curve