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RBRE-119; No. of Pages 4 r e v b r a s r e u m a t o l . 2 0 1 4;x x x(x x):xxx-xxx REVISTA BRASILEIRA DE REUMATOLOGIA w w w . r e u m a t o l o g i a . c o m . b r a b s t r a c t Immune-mediated necrotizing myopathy is a rare and recently described form of idiopathic inflammatory myopathy, frequently misunderstood with polymyositis. Minimal or no inflammatory infiltrate on muscle biopsy is one of the most distinctive features. Gastrointestinal, lung and breast neoplasms are the most common oncologic related causes, but they may occur in patients with others malignancies. This case is the first reported in Brazil and the first associated with neoplasia in Latin America, and highlights the need for clinical suspicion of cancer in patients with idiopathic inflammatory myopathies.Palavras-chave: Miopatias inflamatórias Síndromes paraneoplásicas Neoplasia de ovário r e s u m o A miopatia necrosante imunomediada é forma rara e recentemente descrita de miopatia inflamatória idiopática, frequentemente confundida com polimiosite. Uma das caracterís-ticas mais distintivas é a presença de infiltrado inflamatório mínimo ou a ausência de tal infiltrado à biópsia do músculo. As causas oncológicas relacionadas mais comuns são neoplasias gastrointestinais, do pulmão e de mama, mas pode ocorrer em pacientes com outras doenças malignas. Este caso é o primeiro publicado no Brasil e o primeiro associado à neoplasia na América Latina, destacando a necessidade de suspeita clínica de câncer em pacientes com miopatias inflamatórias idiopáticas.

Background Chagas disease (ChD) is a major cause of non-ischemic cardiomyopathy (NICM) in Latin America and is becoming more frequent in other parts of the world, especially due to immigration movements. Ventricular Tachycardia (VT) is more common in this type of NICM than others, and finding an effective treatment strategy still is a challenge. Catheter ablation is an option, but there is poor data regarding its efficacy and safety. Purpose Evaluate the outcomes after VT catheter ablation in ChD patients. Methods Data were collected by VT studies reports and patient record analysis, including comorbidities and clinical status at baseline and on follow-up. We analyzed all-cause mortality, one-year VT recurrence rate and procedure related major complications. Results Between January 2013 and December 2018, 157 catheter ablation procedures in 121 ChD patients were performed in our institution. The mean follow-up time was 22.6±22.1 (mean ± SD) months. Overall post procedure mortality was 33.1%, and mean survival time was 51.2 months (95% CI: 44.8–58. NYHA functional class (p=0.022), ejection fraction (p=0.020) and immediate ablation result (p 0.002) were predictors of all-cause mortality in the follow-up. Clinical VT inducibility after ablation was a predictor of VT recurrence at one year (p=0.04). An epicardial approach was performed in 125 (79%) procedures, and accidental right ventricle (RV) puncture occurred in 23 (18.4%), in which open-chest surgery for bleeding hemostasis was necessary in 4 procedures (3.2%). Conclusion Mortality and recurrence rates in ChD patients after VT ablation were high, and correlated with heart failure severity. Epicardial approach is often necessary in this subset of patients. There was a correlation between immediate ablation results and recurrence. Kaplan-Meier of cumulative survival Funding Acknowledgement Type of funding source: None

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