Cardiac resynchronization therapy in patients with chronic Chagas cardiomyopathy: long-term follow up

Abstract

IntroductionChagas disease is a major cause of cardiomyopathy and sudden death in our country. It has a high mortality when their patients develop New York Heart Association (NYHA) class IV.ObjectiveThe objective of this study is to analyze the clinical outcome of patients with Chagas' cardiomyopathy with congestive heart failure with optimized pharmacological therapy, undergoing cardiac resynchronization therapy.MethodsBetween January 2004 and February 2009, 72 patients with Chagas' cardiomyopathy in NYHA class III and IV underwent cardiac resynchronization therapy and were monitored to assess their clinical evolution. We used the t test or the Wilcoxon test to compare the same variable in two different times. A P value < 0.05 was established as statistically significant.ResultsThe average clinical follow-up was 46.6 months (range 4-79 months). At the end of the evaluation, 87.4% of patients were in NYHA class I or II (P<0.001). There was response to therapy in 65.3% of patients (P<0.001), with an overall mortality of 34.7%.ConclusionIn patients with chronic Chagas cardiomyopathy undergoing cardiac resynchronization therapy, we found the following statistically significant changes: improvement in NYHA class and increase of left ventricle ejection fraction, a decrease of the systolic final diameter and systolic final left ventricle volume and improvement of patient survival.

Developments in the management of Chagas cardiomyopathy

“…Monitoring of the reactivation of infection with T. cruzi after heart transplantation should be performed routinely. [127] Biventricular pacing could be an effective alternative for selected patients,[131,132] but should be restricted to patients who presented with spontaneous or pacemaker-induced left bundle branch block, since those with right-bundle branch block do not benefit with the implantation of the pacemaker. [133] Multidisciplinary approach of heart failure patients, including cardiac rehabilitation and pharmaceutical care, may be helpful in improving symptoms and quality of life in Chagas disease patients.…”

The treatment of chronic heart failure secondary to Chagas cardiomyopathy in the contemporary era

“…A non-randomized longitudinal study performed on 72 patients with CHF secondary to Chagas cardiomyopathy has shown an increase in the left ventricular ejection fraction and reversed remodeling in such patients on a 47 month mean follow up. 58 Therefore, CRT has the potential to benefit many Chagas disease patients with CHF. Therefore, it is reasonable to indicate CRT to patients with Chagas cardiomyopathy with CHF with a clinical profile similar to that of non-Chagas disease patients in whom CRT is an accepted treatment modality.…”

Chagas Heart Disease: An Update

“…In this group, resynchronization therapy has significantly improved New York Heart Association Functional Class, increased left ventricular ejection fraction, and enhanced survival in patients with chronic Chagas cardiomyopathy. 11 In those patients who fail maximal medical treatment for heart failure, a left ventricular assist device and ultimately cardiac transplantation may be considered.…”