Secondary prevention of sudden cardiac death in chronic chagasic cardiopathy and near-normal ventricular function
Keywords:Chagas Cardiomyopathy, Death, Sudden/prevention & control, Syncope
Introduction: Chronic chagasic cardiopathy (CCC) encompasses a complex spectrum of presentations, and episodes of arrhythmic death in patients with preserved left ventricular (PLVF) or near normal (VFNN) are not uncommon. Methods: Retrospective evaluation of 7 patients with PLVF, submitted for implantation of implantable cardioverter defibrillator (ICD) due to tachycardia or ventricular fibrillation (VT / VF). Clinical, structural and electrocardiographic evaluations were
performed. Results: Mean age was 57.5±4.45 years. Male sex comprised 71.4%. Left ventricular function (LVF) was 56.14%±4.45 with contractile changes in 100% and lower hypokinesia in 85.7%. Functional class I was evidenced in 100% without changes in follow-up. The Rassi score evaluated before the event was 4.85±0.89. Syncope was the initial presentation in 100%, average of 2 episodes per patient and interval of 4 weeks between them. Electrocardiogram showed alterations in 85.71% being right bundle branch block. Sustained VT was evidenced
in 100%; epicardial site in 71.42% and left ventricular anterolateral outlet in 57.14%. The sequential LVF was 54%±3.31; without new contractile changes. Amiodarone and beta-blockers were the drugs used. Appropriate therapies occurred in 100%; average of 2.1 shocks per
patient with 52.63% of the records in the first 14 months. There were no deaths, inappropriate therapies or electrical storm. Conclusion: The high number of therapies corroborates the arrhythmic risk of this population, ratifies the importance of the device and disputes the effectiveness of clinical therapy. Syncope may be associated with an increased risk of arrhythmic events in CCC.
2. Tassi EM, Continentino MA, Nascimento EM, Pereira BB, Pedrosa RC. Relationship between Fibrosis and Ventricular Arrhythmias in Chagas Heart Disease Without Ventricular Disfunction. Arq Bras Cardiol. 2014;102(5):456-64.
3. Sarabanda AVL, Silva RMFL. Cardiomiopatia chagásica e morte súbita: estratificação de risco e prevenção. In: Morte Súbita Cardíaca - SOBRAC. Série clínicas brasileiras de arritmias cardíacas. Volume 5. São Paulo: Editora Atheneu; 2011.
4. Andrade JP, Marin-Neto JA, de Paola AAV, Vilas-Boas F, Oliveira GMM, Bacal F, et al.; Sociedade Brasileira de Cardiologia. I Diretri z Latino Americanapara o diagnóstico e tratamento da cardiopatia chagásica. Arq Bras Cardiol. 2011;97(2 Suppl 3):1-48A.
5. Rassi A Jr, Rassi SG, Rassi A. Morte súbita na doença de Chagas. Arq Bras Cardiol. 2001;76(1):75-85.
6. Sarabanda AVL, Marin-Neto JA. Predictors of mortality in patients with Chagas` cardiomyopathy and ventricular tachycardia not treated with implantable cardioverter-defibrillators. Pacing Clin Electrophysiol. 2011;34(1):54-62.
7. Sarabanda A, Scanavacca M, Sosa E. Ventricular tachycardia in Chagas’ heart disease: preferential locations for reentry circuit sites. Pacing Clin Electrophysiol. 2001;24:722.
8. Rassi A Jr, Rassi A, Little WC, Xavier SS, Rassi SG, Rassi AG, et al. Development and validation of a risk score for predicting death in Chagas heart disease. N Engl J Med 2006;355(8):799-808.
9. Mady C, Cardoso RH, Barretto AC, da Luz PL, Bellotti G, Pileggi F. Survival and predictors of survival in patients with congestive heart failure due to Chagas’ cardiomyopathy. Circulation. 1994;90(6):3098-102.
10. Martinelli Filho M, De Siqueira SF, Moreira H, Fagundes A, Pedrosa A, Nishioka SD, et al. Probability of occurrence of life-threatening ventricular arrhythmias in Chagas’ disease versus non-Chagas’ disease. Pacing Clin Electrophysiol. 2000;23(11 Pt 2):1944-6.
11. Leite LR, Fenelon G, Paes AT, de Paola AAV. The impact of syncope during clinical presentation of sustained ventricular tachycardia on total and cardiac mortality in patients with chronic chagasic heart disease. Arq Bras Cardiol. 2001;77(5):446-52.
12. Martinelli M, Rassi A Jr, Marin-Neto JA, de Paola AA, Berwanger O, Scanavacca M, et al. Chronic use of Amiodarone aGainst Implantable cardioverter-defibrillator therapy for primary prevention of death in patients with Chagas cardiomyopathy Study: rationale and design of a
randomized clinical trial. Am Heart J. 2013;166(6):976-82.e4.