Cardiac Mapping and Imaging in Patients with Ventricular Arrhythmias in Chagas Disease Undergoing Catheter Ablation of Ventricular Tachycardia

Advanced management of ventricular arrhythmias in chronic Chagas cardiomyopathy

“…Microvascular alterations and lack of arteriolar contraction due to inflammation-induced vasodilator substances lead to impaired myocardial perfusion in distal areas of the coronary branches, resulting in tissue death, the presence of segmental disorders of contractility, scar formation, and repolarization abnormalities in the electrocardiogram (ECG). [19][20][21][22][23][24][25][26]…”

“…Cutoff values of 8.3 mV are used in patients with Chagas disease, similar to that for other cardiomyopathies. 24,91 In relation to the duration of local electrograms, values .46 ms identify abnormal areas of slow conduction, with sensitivity and specificity of 83% and 86%, respectively. 27 Placement of a multipolar electrode catheter in the coronary sinus can facilitate the diagnosis of submitral reentry and epicardial late potentials.…”

“…Once the electrograms with delayed components have been identified, a pacemapping strategy can be performed to better identify the critical isthmus and the exit of the circuit. 24,94 In a recent study, a functional substrate map that examines propagation during sinus rhythm for wavefront discontinuities and conduction slowing was shown to identify regions that are critical for reentry. This novel voltage-independent, high-density mapping display can demonstrate the functional substrate for VT during sinus rhythm and guide targeted ablation (Supplemental Video 2).…”

“…96 Recent studies have shown that a VT ablation strategy with a combined endo-epicardial approach in patients with CCC significantly reduces the recurrence of ventricular arrhythmias, without an increase in perioperative complications when performed by experienced groups (Figure 6). 24,27,[97][98][99][100] In a recent randomized controlled study, the efficacy and safety of an endo-epicardial ablation approach (group 1) vs an endocardial approach (group 2) were evaluated in patients with CCC associated with VT. In group 1, nonreinducibility of arrhythmia was achieved in 86% compared to 60% in group 2.…”

“…Catheter orientation aiming at the epicardium and not to the parietal pericardium is of critical importance to avoid damage to extracardiac structures. 24,102,103 Other therapies Radiofrequency ablation is one of the strategies used in patients with VT refractory to antiarrhythmic management; however, the success rate and long-term results remain suboptimal. For this reason, it is convenient to have other therapeutic alternatives.…”