Catheter ablation for ventricular tachycardia in Chagas disease

Abstract

Background Chagas disease (ChD) is a major cause of non-ischemic cardiomyopathy (NICM) in Latin America and is becoming more frequent in other parts of the world, especially due to immigration movements. Ventricular Tachycardia (VT) is more common in this type of NICM than others, and finding an effective treatment strategy still is a challenge. Catheter ablation is an option, but there is poor data regarding its efficacy and safety. Purpose Evaluate the outcomes after VT catheter ablation in ChD patients. Methods Data were collected by VT studies reports and patient record analysis, including comorbidities and clinical status at baseline and on follow-up. We analyzed all-cause mortality, one-year VT recurrence rate and procedure related major complications. Results Between January 2013 and December 2018, 157 catheter ablation procedures in 121 ChD patients were performed in our institution. The mean follow-up time was 22.6±22.1 (mean ± SD) months. Overall post procedure mortality was 33.1%, and mean survival time was 51.2 months (95% CI: 44.8–58. NYHA functional class (p=0.022), ejection fraction (p=0.020) and immediate ablation result (p 0.002) were predictors of all-cause mortality in the follow-up. Clinical VT inducibility after ablation was a predictor of VT recurrence at one year (p=0.04). An epicardial approach was performed in 125 (79%) procedures, and accidental right ventricle (RV) puncture occurred in 23 (18.4%), in which open-chest surgery for bleeding hemostasis was necessary in 4 procedures (3.2%). Conclusion Mortality and recurrence rates in ChD patients after VT ablation were high, and correlated with heart failure severity. Epicardial approach is often necessary in this subset of patients. There was a correlation between immediate ablation results and recurrence. Kaplan-Meier of cumulative survival Funding Acknowledgement Type of funding source: None

Enhancing Ventricular Tachycardia Ablation Outcomes: The Impact of Functional Mapping in Chagas Cardiomyopathy

“…Previous studies have consistently indicated that Chagas cardiomyopathy is associated with elevated rates of VT recurrence and appropriate ICD therapies when compared to other etiologies of cardiomyopathies 2–4 . Given the extensive epicardial and endocardial substrate involved in Chagas VT ablation, it is anticipated that this procedure may carry higher rates of VT recurrence, as indicated in some prior reports 33 .…”

“…Previous studies have consistently indicated that Chagas cardiomyopathy is associated with elevated rates of VT recurrence and appropriate ICD therapies when compared to other etiologies of cardiomyopathies [2][3][4] . Given the extensive epicardial and endocardial substrate involved in Chagas VT ablation, it is anticipated that this procedure may carry higher rates of VT recurrence, as indicated in some prior reports 33 . Our primary finding, which demonstrates reduced rates of VT recurrence in a severe subset of patients, substantiates earlier hypotheses suggesting improved outcomes for patients undergoing functional map-based ablation 34 .…”