Current and emerging therapeutic options for the treatment of chronic chagasic cardiomyopathy

Muratore, Cláudio; Baranchuk, Adrián

doi:10.2147/vhrm.s8355

Cited by 29 publications

(27 citation statements)

References 65 publications

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“…2,3,10 Radiofrequency catheter ablation (RFCA) has been demonstrated to be effective in reducing VT occurrence in patients with Chagas cardiomyopathy. 11 In nonchagasic myocarditis, isolated reports suggest that RFCA of VT may be effective, [12][13][14] but its safety and long-term efficacy in this setting is unclear. This study evaluates safety and effectiveness of RFCA in a series of consecutive patients with persisting drug-refractory VTs after a biopsy diagnosis of myocarditis.…”

Section: Clinical Perspective On P 498mentioning

confidence: 99%

Drug-Refractory Ventricular Tachycardias After Myocarditis

Russo

Casella

Pieroni

et al. 2012

Circ: Arrhythmia and Electrophysiology

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Background-Ventricular tachycardia (VT) is a significant therapeutic challenge in patients with myocarditis. This study aimed to assess the efficacy and safety of radiofrequency catheter ablation (RFCA) of VT in patients with myocarditis. Methods and Results-We enrolled 20 patients (15 men; age, 42 [28-52] years) with a history of biopsy-proven viral myocarditis and drug-refractory VT; 5 patients presented with electrical storm. The median left ventricular ejection fraction was 55% (45-60%). All patients underwent endocardial RFCA with an irrigated catheter, using contact electroanatomic mapping. Recurrence of sustained VT after endocardial RFCA was treated with additional epicardial RFCA. Endocardial RFCA was acutely successful in 14 patients (70%) while in the remaining 6 (30%) clinical VT was successfully ablated by epicardial RFCA. In 1 patient, hemodynamic instability required an intra-aortic balloon pump to complete RFCA. No major complication occurred during or after RFCA. Over a median follow-up time of 28 (11-48) months, 18 patients (90%) remained free of sustained VT; 2 patients (10%, both with baseline left ventricular ejection fraction ≤35%) died of acute heart failure unrelated to ventricular arrhythmias. Conclusions-In patients with myocarditis, RFCA of drug-refractory VT is feasible, safe, and effective. Epicardial RFCA should be considered as an important therapeutic option to increase success rate. (Circ Arrhythm Electrophysiol. 2012;5:492-498.)

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Section: Clinical Perspective On P 498mentioning

confidence: 99%

Drug-Refractory Ventricular Tachycardias After Myocarditis

Russo

Casella

Pieroni

et al. 2012

Circ: Arrhythmia and Electrophysiology

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“…The presence of numerous, polymorphic, and complex extrasystoles is associated with more severe heart disease (16) . The occurrence of VPBs with multiple morphologies is a relatively common fi nding that has been attributed to extensive myocardial damage and correlates with the presence of late potentials observed using signal-averaged ECG (25) .…”

Section: Dynamic Ecg Recording (Holter Monitoring)mentioning

confidence: 82%

Ventricular arrhythmias in Chagas disease

Barbosa

Carmo

Rocha

et al. 2015

Rev. Soc. Bras. Med. Trop.

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Sudden death is one of the most characteristic phenomena of Chagas disease, and approximately one-third of infected patients develop life-threatening heart disease, including malignant ventricular arrhythmias. Fibrotic lesions secondary to chronic cardiomyopathy produce arrhythmogenic substrates that lead to the appearance and maintenance of ventricular arrhythmias. The objective of this study is to discuss the main clinical and epidemiological aspects of ventricular arrhythmias in Chagas disease, the specifi c workups and treatments for these abnormalities, and the breakthroughs needed to determine a more effective approach to these arrhythmias. A literature review was performed via a search of the PubMed database from 1965 to May 31, 2014 for studies of patients with Chagas disease. Clinical management of patients with chronic Chagas disease begins with proper clinical stratifi cation and the identifi cation of individuals at a higher risk of sudden cardiac death. Once a patient develops malignant ventricular arrhythmia, the therapeutic approach aims to prevent the recurrence of arrhythmias and sudden cardiac death by the use of implantable cardioverter defi brillators, antiarrhythmic drugs, or both. In select cases, invasive ablation of the reentrant circuit causing tachycardia may be useful. Ventricular arrhythmias are important manifestations of Chagas cardiomyopathy. This review highlights the absence of high-quality evidence regarding the treatment of ventricular arrhythmias in Chagas disease. Recognizing high-risk patients who require specifi c therapies, especially invasive procedures such as the implantation of cardioverter defi brillators and ablative approaches, is a major challenge in clinical practice.

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“…Unfortunately, only one clinical case has been published of a previous treatment failure with benznidazole and subsequent successful treatment with posaconazole using PCR as follow-up [3] . In the face of relative unsuitability of Chagas patients for heart transplant due to the risks of increased parasitemia when under immunosuppression, the possibility of using stem cells to treat chagasic cardiomyopathy has been viewed with enthusiasm [33] . In 2004, Soares et al [34] demonstrated that intravenous injection of bone marrow cells into chronic chagasic mice resulted in migration to the heart and a significant reduction in inflammatory infiltrates and interstitial fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Emerging and under-recognized Chagas cardiomyopathy in non-endemic countries

Cortez

Providência

Ramos

et al. 2012

WJC

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Due to recent population emigration movements, an epidemic of Chagas disease is currently menacing most developed countries. The authors report the case of a 53-year-old Brazilian woman living in Europe for the last 10 years who developed heart failure symptoms, having a previous symptomatic sinus node disease with a pacemaker implant at age of 40 years. The diagnosis was based on serology and myocardial biopsy and the patient was treated with nifurtimox. The authors emphasize the need of a high level of suspicion in patients with suggestive epidemiology and the need of populational screening of specific high risk groups. New treatment options are also discussed.

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Current and emerging therapeutic options for the treatment of chronic chagasic cardiomyopathy

Cited by 29 publications

References 65 publications

Drug-Refractory Ventricular Tachycardias After Myocarditis

Drug-Refractory Ventricular Tachycardias After Myocarditis

Ventricular arrhythmias in Chagas disease

Emerging and under-recognized Chagas cardiomyopathy in non-endemic countries

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