Catheter ablation of ventricular tachycardia in chagasic cardiomyopathy

Abstract

Summary:There is a limited experience with catheter ablation for treatment of ventricular tachycardia (VT) in Chagasic cardiomyopathy. A 30-year-old woman experienced episodes of palpitations and syncope due to attacks of VT. A diagnosis of Chagas disease was established on a biological basis. Twodimensional echo and contrast ventriculography showed an apical aneurysm with thrombus. Surgery was indicated to resect the aneurysm and ablate the VT. Ventricular tachycardia recurred 1 month later despite therapy, including amiodarone. Two clinical frequent and well-tolerated tachycardias were identified. The site of origin was located in the right ventricular apex and in the apical-lateral wall of the left ventricle, respectively. Catheter ablation was performed at two sites with DC shocks (total energy 600 J) after unsuccessful radiofrequency ablation. Holter recordings performed during the postoperative period showed only infrequent extrasystoles. After follow-up of 24 months the patient remains asymptomatic. Drug-refractory VT in Chagasic cardiomyopathy can be ablated by medium-energy DC shocks after failure of radiofiequency ablation.

Current and emerging therapeutic options for the treatment of chronic chagasic cardiomyopathy

“…The initial reports on successful VT RF ablation in chagasic patients were reported more than 10 years ago 51,52. Since then, the evolution of the mapping techniques as well as the approach from the epicardium has expanded this technique to a larger number of patients.…”

Sudden cardiac death in Chagas' heart disease in the contemporary era

“…No patient had an episode of arrhythmia recurrence on a 9-month follow up in that study. Catheter ablation with DC shocks of a malignant ventricular arrhythmia has also been successfully reported in patients with chronic Chagas' disease occasionally [58]. However, the results of this procedure in the long-term follow up are lacking so that the role of radiofrequency ablation as secondary prevention of sudden cardiac death in patients with chronic Chagas' disease and malignant ventricular arrhythmias remains to be determined.…”

Drug-Refractory Ventricular Tachycardias After Myocarditis

“…In these patients, RFCA (both endocardial and epicardial) has been demonstrated to reduce VT recurrences, [30][31][32] which might in turn help reduce shocks in ICD carriers. Similarly, effective RFCA has been reported in patients with cardiac sarcoidosis, 33,34 whose inflammatory granulomatous lesions often produce structural and clinical features resembling arrhythmogenic right ventricular cardiomyopathy, representing an important cause of ventricular arrhythmias and sudden cardiac death.…”