Chronotropic incompetence in Chagas disease: usefulness of dual sensor pacemaker based on volume minute and accelerometer

Pachón, José Carlos

doi:10.5935/1678-9741.20150011

Cited by 2 publications

(3 citation statements)

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“…Chronotropic incompetence and sick sinus node syndrome may be found in ChD cardiomyopathy (ChHD), even in the latent phase when the heart may be apparently normal. 12 The inflammatory and fibrotic processes may damage sinus cells, destroy the innervation, and cause significant barriers to sinus node impulse progression. 12 However, autoantibodies reported in ChHD may exert sometimes effects in favour of increment or decrease in heart chronotropism, depending on the type of antibody or patient characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…12 The inflammatory and fibrotic processes may damage sinus cells, destroy the innervation, and cause significant barriers to sinus node impulse progression. 12 However, autoantibodies reported in ChHD may exert sometimes effects in favour of increment or decrease in heart chronotropism, depending on the type of antibody or patient characteristics. [13][14][15] Beyond the proposed effects of ivabradine in overall aetiologies, some mechanisms should be taken in account to explain the tendency to reduction of mortality and improvement in functional class ChD HF.…”

Section: Discussionmentioning

confidence: 99%

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Safety profile and efficacy of ivabradine in heart failure due to Chagas heart disease: a post hoc analysis of the SHIFT trial

et al. 2017

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AimsThe SHIFT trial showed that ivabradine reduced heart rate (HR) and the risk of cardiovascular outcomes. Concerns remain over the efficacy and safety of ivabradine on heart failure (HF) due to Chagas disease (ChD). We therefore conducted a post hoc analysis of the SHIFT trial to investigate the effect of ivabradine in these patients.Methods and resultsSHIFT was a randomized, double‐blind, placebo‐controlled trial in symptomatic systolic stable HF, HR ≥ 70 b.p.m., and in sinus rhythm. The ChD HF subgroup included 38 patients, 20 on ivabradine, and 18 on placebo. The ChD HF subgroup showed high prevalence of bundle branch right block and, compared with the overall SHIFT population, lower systolic blood pressure; higher use of diuretics, cardiac glycosides, and antialdosterone agents; and lower use of angiotensin‐converting enzyme inhibitor/angiotensin II receptor blocker or target daily dose of beta‐blocker. ChD HF presented a poor prognosis (all‐cause mortality at 2 years was ~60%). The mean twice‐daily dose of ivabradine was 6.26 ± 1.15 mg and placebo 6.43 ± 1.55 mg. Ivabradine reduced HR from 77.9 ± 3.8 to 62.3 ± 10.1 b.p.m. (P = 0.005) and improved functional class (P = 0.02). A trend towards reduction in all‐cause death was observed in ivabradine arm vs. placebo (P = 0.07). Ivabradine was not associated with serious bradycardia, atrioventricular block, hypotension, or syncope.ConclusionsChD HF is an advanced form of HF with poor prognosis. Ivabradine was effective in reducing HR in these patients and improving functional class. Although our results are based on a very limited sample and should be interpreted with caution, they suggest that ivabradine may have a favourable benefit–risk profile in ChD HF patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Safety profile and efficacy of ivabradine in heart failure due to Chagas heart disease: a post hoc analysis of the SHIFT trial

et al. 2017

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“…These differences can be explained, firstly, by the reduced number of our sample and, secondly, although the increasing evidences of indications for primary prevention in ischemic patients with reduced EF and also because this is an initial experience, the trend was choosing indications in younger patients and without the necessity of using a great quantity of negative chronotropic drugs. It is important to notice that four patients had Chagas disease and it is also well known that approximately 60% of these cases, the sinus node is injured, developing a more or less extensive sick sinus syndrome [ 13 ] and for that reason we must take care when recommending the S-ICD procedure for chagasic patients.…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous Implantable Cardioverter Defibrillator: Early Experience

Souza¹,

Matos²,

Almeida³

et al. 2017

Braz J Cardiovasc Surg

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IntroductionThe implantable cardioverter defibrillator had been increasing the survival of patients at high risk for sudden cardiac death. The subcutaneous implantable cardioverter defibrillator was developed to mitigate the complications inherent to lead placement into cardiovascular system.ObjectiveTo report the initial experience of 18 consecutive cases of subcutaneous implantable cardioverter defibrillator implantation showing the indications, potential pitfalls and perioperative complications.MethodsBetween September 2016 and March 2017, 18 patients with indication for primary and secondary prevention of sudden cardiac death, with no concomitant indication for artificial cardiac pacing, were included.ResultsThe implantation of the subcutaneous implantable cardioverter defibrillator successfully performed in 18 patients. It was difficult to place the subcutaneous lead at the parasternal line in two patients. One patient returned a week after the procedure complaining about an increase in pain intensity at pulse generator pocket site, which was associated with edema, temperature rising and hyperemia. Two patients took antialgic medication for five days after surgery. A reintervention was necessary in one patient to replace the lead in order to correct inappropriate shocks caused by myopotential oversensing.ConclusionIn our initial experience, although the subcutaneous implantable cardioverter defibrillator implantation is a less-invasive, simple-accomplishment procedure, it resulted in a bloodier surgery perhaps requiring an operative care different from the conventional. Inappropriate shock by oversensing is a reality in this system, which should be overcame in order not to become a limiting issue for its indication.

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Chronotropic incompetence in Chagas disease: usefulness of dual sensor pacemaker based on volume minute and accelerometer

Cited by 2 publications

References 15 publications

Safety profile and efficacy of ivabradine in heart failure due to Chagas heart disease: a post hoc analysis of the SHIFT trial

Safety profile and efficacy of ivabradine in heart failure due to Chagas heart disease: a post hoc analysis of the SHIFT trial

Subcutaneous Implantable Cardioverter Defibrillator: Early Experience

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