Amiodarone for arrhythmia in patients with Chagas disease : a systematic review and individual patient data meta-analysis
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Outros Autores: | , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFRGS |
Texto Completo: | http://hdl.handle.net/10183/226252 |
Resumo: | Background Chagas 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. Methodology We 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 findings We 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. Conclusions Amiodarone 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. |
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Stein, CinaraMigliavaca, Celina BorgesColpani, VerônicaRosa, Priscila Raupp daSganzerla, DanielGiordani, Natalia ElisMiguel, Sandro René Pinto de SousaCruz, Luciane NascimentoPolanczyk, Carisi AnneRibeiro, Antônio Luiz PinhoFalavigna, Maicon2021-08-27T04:22:54Z20181932-6203http://hdl.handle.net/10183/226252001129752Background Chagas 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. Methodology We 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 findings We 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. Conclusions Amiodarone 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.application/pdfengPLoS ONE. San Francisco, CA. Vol. 12, no. 8 (Aug. 2018), e0006742, 14 p.Doença de ChagasArritmias cardíacasAmiodaronaRevisão sistemáticaMetanáliseAmiodarone for arrhythmia in patients with Chagas disease : a systematic review and individual patient data meta-analysisEstrangeiroinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFRGSinstname:Universidade Federal do Rio Grande do Sul (UFRGS)instacron:UFRGSTEXT001129752.pdf.txt001129752.pdf.txtExtracted Texttext/plain49657http://www.lume.ufrgs.br/bitstream/10183/226252/2/001129752.pdf.txtae620d2f8879e61fbe861f2c9d510a38MD52ORIGINAL001129752.pdfTexto completo (inglês)application/pdf1322909http://www.lume.ufrgs.br/bitstream/10183/226252/1/001129752.pdfae3cd572842bff0a31c7a92138ad9840MD5110183/2262522021-09-19 04:34:56.212162oai:www.lume.ufrgs.br:10183/226252Repositório de PublicaçõesPUBhttps://lume.ufrgs.br/oai/requestopendoar:2021-09-19T07:34:56Repositório Institucional da UFRGS - Universidade Federal do Rio Grande do Sul (UFRGS)false |
dc.title.pt_BR.fl_str_mv |
Amiodarone for arrhythmia in patients with Chagas disease : a systematic review and individual patient data meta-analysis |
title |
Amiodarone for arrhythmia in patients with Chagas disease : a systematic review and individual patient data meta-analysis |
spellingShingle |
Amiodarone for arrhythmia in patients with Chagas disease : a systematic review and individual patient data meta-analysis Stein, Cinara Doença de Chagas Arritmias cardíacas Amiodarona Revisão sistemática Metanálise |
title_short |
Amiodarone for arrhythmia in patients with Chagas disease : a systematic review and individual patient data meta-analysis |
title_full |
Amiodarone for arrhythmia in patients with Chagas disease : a systematic review and individual patient data meta-analysis |
title_fullStr |
Amiodarone for arrhythmia in patients with Chagas disease : a systematic review and individual patient data meta-analysis |
title_full_unstemmed |
Amiodarone for arrhythmia in patients with Chagas disease : a systematic review and individual patient data meta-analysis |
title_sort |
Amiodarone for arrhythmia in patients with Chagas disease : a systematic review and individual patient data meta-analysis |
author |
Stein, Cinara |
author_facet |
Stein, Cinara Migliavaca, Celina Borges Colpani, Verônica Rosa, Priscila Raupp da Sganzerla, Daniel Giordani, Natalia Elis Miguel, Sandro René Pinto de Sousa Cruz, Luciane Nascimento Polanczyk, Carisi Anne Ribeiro, Antônio Luiz Pinho Falavigna, Maicon |
author_role |
author |
author2 |
Migliavaca, Celina Borges Colpani, Verônica Rosa, Priscila Raupp da Sganzerla, Daniel Giordani, Natalia Elis Miguel, Sandro René Pinto de Sousa Cruz, Luciane Nascimento Polanczyk, Carisi Anne Ribeiro, Antônio Luiz Pinho Falavigna, Maicon |
author2_role |
author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Stein, Cinara Migliavaca, Celina Borges Colpani, Verônica Rosa, Priscila Raupp da Sganzerla, Daniel Giordani, Natalia Elis Miguel, Sandro René Pinto de Sousa Cruz, Luciane Nascimento Polanczyk, Carisi Anne Ribeiro, Antônio Luiz Pinho Falavigna, Maicon |
dc.subject.por.fl_str_mv |
Doença de Chagas Arritmias cardíacas Amiodarona Revisão sistemática Metanálise |
topic |
Doença de Chagas Arritmias cardíacas Amiodarona Revisão sistemática Metanálise |
description |
Background Chagas 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. Methodology We 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 findings We 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. Conclusions Amiodarone 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. |
publishDate |
2018 |
dc.date.issued.fl_str_mv |
2018 |
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2021-08-27T04:22:54Z |
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PLoS ONE. San Francisco, CA. Vol. 12, no. 8 (Aug. 2018), e0006742, 14 p. |
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