Efficacy of amiodarone during long-term treatment of malignant ventricular arrhythmias in patients with chronic chagasic myocarditis

2 nd Brazilian Consensus on Chagas Disease, 2015

“…In cases of life-threatening arrhythmias (NSVT, SVT, and ventricular fibrillation), the most effective antiarrhythmic, nd Brazilian Consensus on Chagas Disease, 2015 and the safer to use, is amiodarone (241) . It is necessary to pay attention to the side effects of this drug -that are generally related to the cumulative dose -which can trigger serious bradyarrhythmias.…”

Sudden death in Chagas' disease

“…Therefore, therapeutical assays with drugs of the classes IA, IB, IC, and III were carried out [78][79][80][81][82][83][84][85][86][87] and, in almost all of them, efficacy of the antiarrhythmic drugs on ventricular arrhythmias was observed. However, as suppression of ectopic ventricular beats does not necessarily imply a reduction in mortality [88][89][90] , when we choose to routinely admi- nister antiarrhythmic drugs to chagasic patients with complex ventricular arrhythmias, we should know that it is possible to reduce the incidence of sudden death with the prophylactic treatment.…”

“…Extrapolating these data to chronic Chagas' heart disease, about which proper therapeutical assays are lacking, we believe that administration of amiodarone to chagasic patients with complex ventricular arrhythmias is totally justified, particularly when the arrhythmia in question is nonsustained ventricular tachycardia accompanied by ventricular dysfunction. In addition to reducing mortality, amiodarone has an extraordinary antiectopic efficacy 82,84,85,87 , a low incidence of significant side effects 99,100 and proarrhythmia 101 , particularly when administered in low doses, and, only exceptionally, does it change inotropism. Therefore, amiodarone may be used even in severe impairment of ventricular function, including the treatment of decompensated heart failure, which in chronic Chagas' heart disease is accompanied by complex ventricular arrhythmia in almost all cases 43 .…”

I Diretriz Latino-Americana para o Diagnóstico e Tratamento da Cardiopatia Chagásica

“…Patients with CCC, mainly those with electrocardiographic changes, regional or global ventricular dysfunction and HF, usually have a high density of ventricular arrhythmias 209,210 . In those patients, Holter monitoring should be performed independently of symptoms, because it can identify complex arrhythmias, impacting on the treatment and prognosis 79,85 .…”

“…The ideal anatomical substrate for reentry is present in CCC, justifying the programmed ventricular stimulation protocol to assess the possibility of inducing reentrant arrhythmias 209,210 . Being an invasive exam, the EPS can cause more risks than benefits in patients with the indeterminate form of disease.…”