Incidence and variables associated with arrhythmias during dobutamine–atropine stress echocardiography among patients with Chagas disease

Abstract

Background Dobutamine stress echocardiography (DSE) is an important tool in the diagnosis of coronary artery disease. However, there is hesitation in clinical practice for using it in patients with Chagas disease (CD) due to the arrhythmogenic potential of this heart condition. This study aimed to evaluate the incidence and variables associated with arrhythmias during DSE in a population of patients with CD. Methods A population of 205 consecutive patients with CD and suspected coronary heart disease was assessed through a retrospective database analysis. CD was confirmed in all patients by serological testing. Results The mean age of the patients selected was 64 years, and 65.4% of the patients were female. Significant arrhythmias occurred as follows: nonsustained ventricular tachycardia in 7.3% of patients; supraventricular tachycardia and sustained ventricular tachycardia in 1%; and atrial fibrillation in 0.5%. Nonsignificant arrhythmias occurred as follows: premature ventricular contractions in 48% of patients and bigeminy in 4.4%. Values for the wall‐motion score index at rest greater than 1.12 and 1.18 were independently correlated with the occurrence of nonsignificant arrhythmias (odds ratio [OR] = 2.90, P < 0.001) and significant arrhythmias (OR = 4.23, P = 0.044), respectively. Conclusion DSE should be considered a safe examination in patients with CD despite the known increased risk of arrhythmias in this group of patients. The occurrence of arrhythmias was low in this study. Abnormal wall‐motion score index values at rest were associated with the occurrence of significant and nonsignificant arrhythmias during the test.

Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023

“… 422 Embora o exame farmacológico use comumente a dobutamina, provida de potencial arritmogênico, evidenciou-se segurança do método na CCDC, sendo o índice de contração segmentar alterado em repouso um preditor independente para o surgimento de arritmias durante o exame. 423 …”

“… 422 Although the pharmacological test usually uses dobutamine, which has an arrhythmogenic potential, the method proved safe in CCCD, and an altered segmental contraction index at rest is an independent predictor of arrhythmias during the test. 423 …”

Perspectiva actual en manejo de Arritmias en Cardiomiopatía Chagásica

“…Las manifestaciones más características de la enfermedad se presentan en la fase crónica con afectación de la musculatura estriada cardiaca generando miocardiopatía dilatada, injuria en la función global del ciclo cardiaco con presencia del descenso de la fracción de eyección y alteraciones segmentarias de la contractilidad, e infiltración del parásito directamente en el sistema de conducción produciendo distintos tipos de alteraciones electrocardiográficas como bloqueos de ramas completos e incompletos, contracciones ventriculares prematuras, arritmias supraventriculares sostenidas, arritmias ventriculares refractarias, bloqueos de la conducción auriculoventricular en sus diferentes grados, alteraciones de la repolarización y entre otros (5,6,7).…”