One-year cardiac morphological and functional evolution following permanent pacemaker implantation in right ventricular septal position in chagasic patients

Abstract

Introduction: The septal position is an alternative site for cardiac pacing (CP) that is potentially less harmful to cardiac function. Methods: Patients with Chagas disease without heart failure submitted to permanent pacemaker (PP) implantation at the Clinics Hospital of the Triângulo Mineiro Federal University (UFTM), were selected from February 2009 to February 2010. The parameters analyzed were ventricular remodeling, the degree of electromechanical dyssynchrony (DEM), exercise time and VO2 max during exercise testing (ET) and functional class (NYHA). Echocardiography was performed 24 to 48h following implantation and after one year follow-up. The patients were submitted to ET one month postprocedure and at the end of one year. Results: Thirty patients were included. Patient mean age was 59±13 yearsold. Indication for PP implantation was complete atrioventricular (AV) block in 22 (73.3%) patients and 2 nd degree AV block in the other eight (26.7%). All patients were in NYHA I and no changes occurred in the ET parameters. No variations were detected in echocardiographic remodeling measurements. Intraventricular dyssynchrony was observed in 46.6% of cases and interventricular dyssynchrony in 33.3% of patients after one year. Conclusions: The findings of this work suggest that there is not significant morphological and functional cardiac change following pacemaker implantation in septal position in chagasic patients with normal left ventricular function after one year follow-up. Thus, patients may remain asymptomatic, presenting maintenance of functional capacity and no left ventricular remodeling.

Effect of pacemaker site on B-type natriuretic peptide levels and left ventricular function in a population with high prevalence of Chagas disease

“…Chagas). Previous similar studies have been relatively small, with current literature showing conflicting resultssome supporting that NAP results in slower progression of Chagas cardiomyopathy [10], and others showing no morphological and functional differences between NAP and AP groups at 1 year [11].…”

“…It is also impossible to rule out that the slightly worse baseline cardiac function in the AP group could have influenced the myocardial response to artificial pacing. Our study, like many previous, involved a heterogeneous population, limiting definite conclusions about specific patient subgroups [10,11] (e.g. Chagas).…”

New Imaging Parameters to Predict Sudden Cardiac Death in Chagas Disease

“…On the other hand, the method is less sensitive to evaluate the presence of fibrosis and is not able to detect inflammation. Echocardiography may potentially be used to study ventricular dyssynchrony in CHD [21,22]. Duarte et al [22] reported that the prevalence of interventricular dyssynchrony was 34% and of intraventricular dyssynchrony was 85%.…”