Implantable cardioverter defibrillators and Chagas' disease: results of the ICD Registry Latin America

Muratore, Cláudio; Batista, Luiz Antonio; Chiale, Pablo A.; Eloy, R; Tentori, María Cristina; Escudero, Jaime; Lima, Antônio Malan Cavalcanti; Medina, Luís; Garillo, Raúl; Maloney, Jennifer

doi:10.1093/europace/eun325

Cited by 68 publications

(50 citation statements)

References 19 publications

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“…Myocardial fi brosis and areas of slow electrical conduction result in mechanical alterations in both timing and function. With the development of therapeutic strategies to prevent death from ventricular fi brillation, particularly the use of implantable cardioverter-defi brillators (ICDs), accurate patient stratifi cation based on the future risk of arrhythmic events has become very relevant in ChD (3) .…”

Section: Of Great Frequency Are Also the Sudden Deaths In The Cardiacmentioning

confidence: 99%

New predictors of malignant ventricular arrhythmias in Chagas disease: searching for the holy grail

Barros

2015

Rev. Soc. Bras. Med. Trop.

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(Carlos Chagas, 1916) (1) Since the fi rst descriptions of Chagas disease (ChD), sudden death is considered one of the characteristics and responsible for >50% of the mortality in chagasic patients with heart failure. In this issue of RSBMT, Barbosa et al (2) . highlight several important aspects of the pathogenesis, prognosis, and treatment of ventricular arrhythmias in ChD (2) . Chagas disease has an essentially arrhythmogenic nature characterized by dense and complex ventricular arrhythmias; therefore, ventricular fi brillation likely constitutes the terminal event in most cases of sudden death, which accounts for the majority of deaths in ChD. Chagas cardiomyopathy gives rise to the most intense fi brous reaction amongst all causes of myocarditis, leading to severe disorganization of the myocardial architecture and structure. In addition to the fi brotic substrate, electrical dispersion plays an important role in arrhythmogenesis, and it is caused by areas of slow conduction leading to electrical instability. Myocardial fi brosis and areas of slow electrical conduction result in mechanical alterations in both timing and function. With the development of therapeutic strategies to prevent death from ventricular fi brillation, particularly the use of implantable cardioverter-defi brillators (ICDs), accurate patient stratifi cation based on the future risk of arrhythmic events has become very relevant in ChD (3) .A major therapeutic goal in the management of Chagas cardiomyopathy is prevention of sudden cardiac death. While ICD therapy is the standard treatment for secondary prevention of cardiac arrest, the strategy for primary prevention of cardiac arrest in Chagas cardiomyopathy is much more controversial. Although several clinical features have been assessed as possible risk factors for the development of fatal arrhythmias, the sensitivity and specifi city of any single test to predict fatal arrhythmias are limited. For example, left ventricular dysfunction is recognized as a strong general risk predictor, particularly for arrhythmic death in ChD (4) ; however, the mere presence of a depressed left ventricular ejection fraction (LVEF) is not sensitive or specifi c enough to stratify the risk of sudden death. Most patients with ChD that have an ICD for secondary prevention and thus have experienced a potentially fatal arrhythmic event have an LVEF >30%. Electrocardiographic techniquesIn the last few years, several new electrocardiographic methods have been used to predict mortality in ChD including measurement of the length of the QRS and QT intervals from a standard 12-lead ECG, which is a simple and inexpensive method of risk assessment in ChD. QT dispersion is associated with left ventricular (LV) systolic dysfunction, and both increased QT dispersion and QT interval are related to a higher risk of death in ChD patients (5) . Moreover, in another study performed in the same study sample, T-wave axis deviation was a strong and independent predictor of mortality risk. Furthermore,

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Section: Of Great Frequency Are Also the Sudden Deaths In The Cardiacmentioning

confidence: 99%

New predictors of malignant ventricular arrhythmias in Chagas disease: searching for the holy grail

Barros

2015

Rev. Soc. Bras. Med. Trop.

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“…4,5 Patients also require palliative care for the cardiomyopathy, ranging from drug therapy to pacemakers and cardiac transplants. 6 Thus treatment can cost up to over 1,000 USD per year and per patient. 7 Prevention currently only relies on vector control, which has considerably reduced disease incidence and prevalence in most Latin America.…”

Section: Introductionmentioning

confidence: 99%

Advances and challenges towards a vaccine against Chagas disease

Quijano-Hernández

Dumonteil

2011

Human Vaccines

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“…Studies by Muratore et al (50), (51) and Fonseca et al (53) found no difference between the populations with and without Chagas disease in the numbers of arrhythmia episodes, shocks, and deaths. In contrast, the studies by Martinelli-Filho et al (44) , Rabinovich et al (51) , Moreira (49) , Cardinalli-Neto et al (54) , Cardinalli-Neto et al (55) , Barbosa et al (52) and the ICD registry for patients with Chagas disease in Latin America, published in 2009 (56) , found differences between the chagasic and non-chagasic populations. ChD groups had higher numbers of ventricular arrhythmias, a higher percentage of patients receiving appropriate therapy and increased numbers of shocks overall.…”

Section: Implantable Cardioverter Defi Brillatormentioning

confidence: 92%

“…The groups did not differ in the outcomes for mortality and the number of inappropriate shocks. Mortality predictors for Chagas disease patients with ICDs were the following: the number of shocks per patient (56) , age ≥ 65 years 57 and LVEF ≤ 30% (57) . Martinelli et al (58) investigated 116 consecutive ChD patients with ICDs implanted for the secondary prevention of arrhythmias; 50% of the cohort received appropriate shock therapy.…”

Section: Implantable Cardioverter Defi Brillatormentioning

confidence: 99%

Ventricular arrhythmias in Chagas disease

Barbosa

Carmo

Rocha

et al. 2015

Rev. Soc. Bras. Med. Trop.

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Sudden death is one of the most characteristic phenomena of Chagas disease, and approximately one-third of infected patients develop life-threatening heart disease, including malignant ventricular arrhythmias. Fibrotic lesions secondary to chronic cardiomyopathy produce arrhythmogenic substrates that lead to the appearance and maintenance of ventricular arrhythmias. The objective of this study is to discuss the main clinical and epidemiological aspects of ventricular arrhythmias in Chagas disease, the specifi c workups and treatments for these abnormalities, and the breakthroughs needed to determine a more effective approach to these arrhythmias. A literature review was performed via a search of the PubMed database from 1965 to May 31, 2014 for studies of patients with Chagas disease. Clinical management of patients with chronic Chagas disease begins with proper clinical stratifi cation and the identifi cation of individuals at a higher risk of sudden cardiac death. Once a patient develops malignant ventricular arrhythmia, the therapeutic approach aims to prevent the recurrence of arrhythmias and sudden cardiac death by the use of implantable cardioverter defi brillators, antiarrhythmic drugs, or both. In select cases, invasive ablation of the reentrant circuit causing tachycardia may be useful. Ventricular arrhythmias are important manifestations of Chagas cardiomyopathy. This review highlights the absence of high-quality evidence regarding the treatment of ventricular arrhythmias in Chagas disease. Recognizing high-risk patients who require specifi c therapies, especially invasive procedures such as the implantation of cardioverter defi brillators and ablative approaches, is a major challenge in clinical practice.

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Implantable cardioverter defibrillators and Chagas' disease: results of the ICD Registry Latin America

Abstract: This registry confirms that ICD therapy provides protection by effectively terminating life-threatening arrhythmias in patients with Chagas' disease. This is especially so when patients receive the device for secondary prevention.

Cited by 68 publications

References 19 publications

New predictors of malignant ventricular arrhythmias in Chagas disease: searching for the holy grail

New predictors of malignant ventricular arrhythmias in Chagas disease: searching for the holy grail

Advances and challenges towards a vaccine against Chagas disease

Ventricular arrhythmias in Chagas disease

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