BACKGROUND: Chagas cardiomyopathy (CCM) is a significant cause of ventricular arrhythmias and sudden cardiac death (SCD). Although, implantable cardiac defibrillators (ICD) have been used for all forms of non-ischemic cardiomyopathy (NICM), studies on ICD efficacy in CCM are scarce. OBJECTIVE: The present study aims to compare the long-term outcomes, mortality rates, and the occurrence of tachycardia therapies after ICD implantation in patients with CCM and NICM. METHODS: The study was conducted over an 18-year period beginning in 2003. The primary outcome of this study was the difference in appropriate ICD therapies and mortality among patients in a single center receiving implant for CCM or NICM management. As a secondary outcome, we compared inappropriate shocks, presence of incessant ventricular tachycardia/electrical storm, and SCD. RESULTS: The study included 207 patients (117 with CCM and 90 with NICM). The median follow-up time was 61 months [25-121] in the CCM group and 56.5 months [23-119] in the NICD group. During follow up, 39.3 % (46 patients) died in the CCM group and 5.6 % (5 patients) in the NICM group. Appropriate shocks, appropriate therapies, ATP, electrical storm and inappropriate shocks were all more frequent in patients with CCM. CONCLUSION: CCM patients experienced higher mortality and more frequent appropriate ICD interventions compared to patients with NICM. ICDs appear effective and safe for long-term management in CCM.