Prevalence of atrial fibrillation and conduction abnormalities in Chagas disease: a systematic review and an updated meta-analysis

BACKGROUND: Chagas disease (CD) remains a significant public health problem and may progress to Chagas cardiomyopathy (ChCM), a distinct inflammatory–fibrotic myocardial phenotype characterized by a high burden of atrial fibrillation (AF) and conduction system abnormalities. Updated estimates of the prevalence of these electrical disturbances are essential to inform clinical risk stratification and guideline development. OBJECTIVE: This updated meta-analysis aimed to evaluate the prevalence of AF and Conduction Abnormalities in ChCM. METHODS: We conducted a comprehensive systematic review and meta-analysis of 33 studies published through February 2025, comprising 17,100 participants, of whom 6,644 had ChCM. The prevalence of AF and conduction abnormalities was evaluated in individuals with ChCM compared with non-Chagas controls, including healthy individuals and patients with CD and non-ChCM. Pooled estimates were generated using random-effects models, with formal assessment of between-study heterogeneity and publication bias. The review protocol was prospectively registered in PROSPERO (CRD420251005184). RESULTS: AF was significantly more prevalent in ChCM (9.9%) than in controls (6.6%; OR = 1.88, 95% CI: 1.46–2.42). Among patients with cardiomyopathy, AF was more frequent in CD patients (12.1% vs. 9.5%; OR = 1.31, 95% CI: 1.07–1.60). Compared with ischemic cardiomyopathy, ChCM was associated with a higher AF risk (OR = 1.55; 95% CI: 1.13–2.12), whereas no difference was observed with dilated cardiomyopathy. Other conduction abnormalities were markedly more common in ChCM: first-degree atrioventricular block (OR = 2.71, 95% CI: 1.66–4.44), right bundle branch block (isolated or with left anterior fascicular block), and second-degree atrioventricular block. CONCLUSIONS: This updated meta-analysis demonstrates that Chagas cardiomyopathy is associated with a higher prevalence of atrial fibrillation and conduction abnormalities compared with other cardiomyopathy subtypes. These findings highlight the distinctive arrhythmogenic profile of Chagas cardiomyopathy and support the need for systematic electrocardiographic surveillance and heightened clinical awareness in affected patients. Future studies are warranted to define thromboembolic risk better, optimize rhythm management, and inform disease-specific strategies to reduce morbidity and mortality in populations affected by Chagas disease.