Sudden Cardiac Death Risk Stratification and Prevention in Chagas Disease: A Non-systematic Review of the Literature

Abstract

Chagas disease is an important public health problem in Latin America. However, migration and globalisation have resulted in the increased presence of Chagas disease worldwide. Sudden cardiac death is the leading cause of death in people with Chagas disease, most often due to ventricular fibrillation. Although more common in patients with documented ventricular arrhythmias, sudden cardiac death can also be the first manifestation of Chagas disease in patients with no previous symptoms or known heart failure. Major predictors of sudden cardiac death include cardiac arrest, sustained and non-sustained ventricular tachycardia, left ventricular dysfunction, syncope and bradycardia. The authors review the predictors and risk stratification score developed by Rassi et al. for death in Chagas heart disease. They also discuss the evidence for anti-arrhythmic drugs, catheter ablation, ICDs and pacemakers for the prevention of sudden cardiac death in these patients. Given the widespread global burden, understanding the risk stratification and prevention of sudden cardiac death in Chagas disease is of timely concern.

Heart rate variability as a biomarker in patients with Chronic Chagas Cardiomyopathy with or without concomitant digestive involvement and its relationship with the Rassi score

“…One of the leading causes of death in CD is sudden cardiac death, where the most common underlying mechanism is the occurrence of sustained ventricular tachycardia or fibrillation [ 6 , 8 , 9 , 32 , 34 , 35 ]. Although ventricular fibrillation is causally associated with widespread cardiac fibrosis induced by the persistent infection by T. cruzi , cardiac dysautonomia is also likely to play an important role to trigger sudden death in patients with CCC.…”

“…Although ventricular fibrillation is causally associated with widespread cardiac fibrosis induced by the persistent infection by T. cruzi , cardiac dysautonomia is also likely to play an important role to trigger sudden death in patients with CCC. Although the intrinsic mechanism, whereby autonomic impairment increases susceptibility to life threatening arrhythmias is still unclear in CD, it is plausible to consider that it may lead to abnormal excitability and conductibility properties of cardiomyocytes [ 9 , 11 , 32 , 36 – 39 ]. Moreover, although impairment of parasympathetic control of the sinus node is well described in CD [ 40 , 41 ], the effects of cardiac denervation associated with the T. cruzi infection are more complex at the ventricular level.…”

“…Individuals with Chronic Chagas Cardiomyopathy (CCC) have the most frequent and more ominous form of CD, representing the potential evolution of 40% of T. cruzi infected subjects. CCC entails the development of serious cardiac complications, for instance, ventricular aneurysms, systemic and pulmonary thromboembolism, heart failure and complex arrhythmias, the latter representing one of the most important risk factors for sudden death [ 8 , 9 ]. Various mechanisms have been considered to be involved in the pathogenesis of CCC, including microvascular disturbances, parasite-dependent and immune-mediated myocardial damage, and cardiac dysautonomia [ 2 , 6 , 7 ].…”

Molecular and Clinical Aspects of Chronic Manifestations in Chagas Disease: A State-of-the-Art Review

“…In some of these patients, autonomic symptoms may be absent due to the destruction of sympathetic and parasympathetic nerve endings. Finally, SCD is one of the leading causes of death in patients with a cardiac phenotype of chronic CD, accounting for almost 60% of all deaths [140][141][142].…”

Recognition and screening for Chagas disease in the USA

“…Even in patients with advanced CD cardiomyopathy, diagnosis and monitoring are still clinically important, as antiarrhythmics, implantable cardioverter-defibrillator placement, and heart transplant are still recommended. 55 Cardiac evaluation and treatment of patients with more significant disease should recognize the unusually high risk of adverse outcomes, particularly stroke 71 and sudden death, 72 in patients with CD cardiomyopathy.…”