Perfil clínico de pacientes chagásicos e não-chagásicos portadores de marca-passo cardíaco artificial

Abstract

A doença de Chagas é uma patologia endêmica, de larga distribuição nas Américas Central e do Sul. A doença é encontrada em 21 países deste continente, com cerca de16 a 18 milhões de pessoas infectadas e cem milhões em risco de adquiri-la 21 . A miocardite crônica fibrosante que ocorre na fase crônica da doença é responsável não só pela perda da função contrátil do miocárdio como também pelo ABSTRACTThe aim of this study was to compare Chagas and non-Chagas' disease patients using single or dual-chamber pacemaker in relation to the ejection fraction of the left ventricle, the ventricular stimulation threshold and the occurrence of ventricular arrhythmia. From January, 2001 to November, 2002, 45 Chagas' disease patients and 35 non-Chagas' disease patients, all pacemaker users, were evaluated considering clinical history, echocardiographic study, Holter monitoring and analysis of the pacemaker telemetry data. Chagas' disease patients were significantly younger, but both groups were similar when chest X-Ray variables and right ventricular stimulation threshold were analyzed. Chagas' disease patients had a lower left ventricular ejection fraction and more frequent ventricular arrhythmia during Holter monitoring. A positive correlation between the low ejection fraction of the left ventricle and the intensity of ventricular arrhythmia was observed. In conclusion, among pacemaker user patients, Chagas' disease is related to cardiac markers of worse prognosis. Key-words: Chagas' disease. Pacemaker. Arrhythmia. Telemetry.comprometimento do sistema de condução do coração, por variados tipos de arritmias e sua associação não rara com a morte súbita 13 . A importância do bloqueio atrioventricular na doença de Chagas foi reconhecida desde os estudos iniciais de Chagas e Villela 7 , constituindose ainda hoje uma das mais freqüentes indicações para implante de marcapasso no Brasil.

Electrocardiographic Abnormalities in Trypanosoma cruzi Seropositive and Seronegative Former Blood Donors

“…Right bundle branch block, frequently combined with left anterior fascicular block, is the most characteristic ECG abnormality in ChD [10] and is associated with higher risk of death in longitudinal studies [13], [32]. ChD patients with pacemakers have lower LVEF comparative to pacemaker patients without ChD [33]. In contrast to what we found in this study, frequent ventricular ectopic beats have been repeatedly related to LVEF depression in ChD [26], [34] and the observed association of supraventricular ectopic beats with LV dysfunction has not been reported before.…”

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

“…Garcia Rincon et al48 reported that chagasic patients implanted with permanent pacemakers were younger (55 versus 68 years old; P < 0.001), with lower LVEF (55 versus 60%; P < 0.04) and with more frequent ventricular arrhythmias in Holter monitoring than implanted patients with no Chagas’ disease 48…”

Inhibition of calcium/calmodulin (Ca 2+ /CaM)—Calcium/calmodulin‐dependent protein kinase II (CaMKII) axis reduces in vitro and ex vivo arrhythmias in experimental Chagas disease

“…However, from this initial study, we intended to reproduce severe bradycardia and sinoatrial block, which are common in chagasic patients. 1,60 Also, we conducted all experiments with a fixed concentration of KN-93. Future studies, particularly in vivo should be conducted to establish the degree of Ca 2+ / CaM-CaMKII axis inhibition that optimizes its therapeutic efficacy.…”