Thoracoscopic sympathectomy for incessant polymorphic ventricular tachycardia in chronic chagasic myocarditis A case report

Ventricular arrhythmias in Chronic Chagas' Myocardiopathy: A case report and brief review of different antiarrhythmic strategies

“…Radiofrequency ablation may be considered for patients suffering sustained VT unresponsive to pharmacologic therapy [7]. Other reported antiarrhythmic approaches for treatment of VT unresponsive to pharmacological therapy and catheter ablation are apical aneurysmectomy [8], thoracoscopic sympathectomy [9] and ethanol transcoronary ablation [10]. Nevertheless, general results of these techniques may be considered disappointing.…”

Prophylaxis of sudden cardiac death in chronic Chagas' disease

“…However, in view of the large areas of reparative and confluent myocardial fibrosis detected throughout the myocardium in patients with this condition [10], several different sites of arrhythmia exist, thus precluding the widespread use of Sosa et al's [10] method to treat malignant ventricular arrhythmias in Chagas' disease patients. Thus, the report by Gutierrez et al [1] is reassuring by the fact that a combination of thoracoscopic sympathectomy followed by ICD implantation may be of value to avert sudden cardiac death in selected patients with malignant ventricular arrhythmias due to Chagas' disease.…”

“…We read with interest the letter from Kováts et al The authors reported extremely elevated natriuretic peptidelevels in an elderly woman with bradycardia due to sinus arrest with a junctional escape rhythm induced by betablocker therapy [1]. Cessation of the medication resulted in sinus rhythm and a rapid decrease of the natriuretic peptidelevel.…”

“…We would like to make some comments on the excellent paper by Gutierrez et al, who described a case of a patient with incessant polymorphic ventricular tachycardia and subsequent sudden cardiac death associated with chronic Chagas' heart disease [1].…”

“…Gutierrez et al [1] ascribed the appearance of such dysrhythmia to an autonomic imbalance, and for this reason performed a therapeutic thoracoscopic sympathectomy as a last resort. In this sense, it is noteworthy to stress that an increase in the myocardial adrenaline release can be detected in Chagas' disease patients with left ventricular dysfunction [8], which might facilitate noradrenaline release from the intracardiac sympathetic nerves, thus providing the substrate for the appearance of incessant polymorphic ventricular tachycardia.…”