Electrical Storm in Chagas Cardiomyopathy

Pavão, Maria Licia Ribeiro Cury; Arfelli, Elerson; Scorzoni-Filho, A.; Pavão, Rafael Brolio; Pazin‐Filho, Antônio; Marin-Neto, José Antônio; Schmidt, André

doi:10.1016/j.jacep.2020.04.028

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…Historically, VT has been associated with substantial morbidity and mortality because of their role in SCD, and it was thought that their presence, duration, and complexity were related to the severity of the regional wall motion abnormalities (RWMA). However, in a recent large observational study with more than 100 enrolled patients diagnosed with Ch-CMP, electrical storms (ES), defined as three or more distinct episodes of sustained VT or VF (ventricular fibrillation) within 24 h conferred no difference in mortality [ 68 ]. Moreover, a depressed left ventricular ejection fraction (LVEF) was not associated with the presence of ES, and a shorter QRS duration was seen among these patients, probably indicating a more preserved conduction system, which can be a surrogate marker of a less affected LV [ 68 ].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…However, in a recent large observational study with more than 100 enrolled patients diagnosed with Ch-CMP, electrical storms (ES), defined as three or more distinct episodes of sustained VT or VF (ventricular fibrillation) within 24 h conferred no difference in mortality [ 68 ]. Moreover, a depressed left ventricular ejection fraction (LVEF) was not associated with the presence of ES, and a shorter QRS duration was seen among these patients, probably indicating a more preserved conduction system, which can be a surrogate marker of a less affected LV [ 68 ]. Therefore, there is still uncertainty regarding the most prominent factor contributing to ES in Ch-CMP.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

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Chagas Cardiomyopathy: From Romaña Sign to Heart Failure and Sudden Cardiac Death

et al. 2021

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Despite nearly a century of research and accounting for the highest disease burden of any parasitic disease in the Western Hemisphere, Chagas disease (CD) is still a challenging diagnosis, primarily due to its poor recognition outside of Latin America. Although initially considered endemic to Central and South America, globalization, urbanization, and increased migration have spread the disease worldwide in the last few years, making it a significant public health threat. The international medical community’s apparent lack of interest in this disease that was previously thought to be geographically restricted has delayed research on the complex host–parasite relationship that determines myocardial involvement and its differential behavior from other forms of cardiomyopathy, particularly regarding treatment strategies. Multiple cellular and molecular mechanisms that contribute to degenerative, inflammatory, and fibrotic myocardial responses have been identified and warrant further research to expand the therapeutic arsenal and impact the high burden attributed to CD. Altogether, cardiac dysautonomia, microvascular disturbances, parasite-mediated myocardial damage, and chronic immune-mediated injury are responsible for the disease’s clinical manifestations, ranging from asymptomatic disease to severe cardiac and gastrointestinal involvement. It is crucial for healthcare workers to better understand CD transmission and disease dynamics, including its behavior on both its acute and chronic phases, to make adequate and evidence-based decisions regarding the disease. This review aims to summarize the most recent information on the epidemiology, pathogenesis, clinical presentation, diagnosis, screening, and treatment of CD, emphasizing on Chagasic cardiomyopathy’s (Ch-CMP) clinical presentation and pathobiological mechanisms leading to sudden cardiac death.

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Section: Clinical Manifestationsmentioning

confidence: 99%

Section: Clinical Manifestationsmentioning

confidence: 99%

Chagas Cardiomyopathy: From Romaña Sign to Heart Failure and Sudden Cardiac Death

et al. 2021

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The imperfect storm: An uncommon presentation of Chagas disease

Johnson

Wang

2022

The American Journal of Emergency Medicine

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Teste de Limiar de Desfibrilação e Seguimento a Longo Prazo de Pacientes com Cardiopatia Crônica da Doença de Chagas

Campos¹,

Bernardes²,

Melo³

et al. 2022

Arquivos Brasileiros De Cardiologia

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Fundamento: A morte súbita cardíaca (MSC) é a causa mais comum de óbito na cardiomiopatia crônica da doença de Chagas (CCDC). Visto que muitos pacientes com CCDC que são candidatos a receber um cardioversor desfibrilador implantável (CDI) atendem a critérios que sugerem alto risco de apresentarem limiares de desfibrilação elevados, sugere-se realizar um teste de limite de desfibrilação (LDF). Objetivos: Investigamos o uso do teste de LDF em pacientes com CCDC, com enfoque nos óbitos relacionados ao implante do CDI e na ocorrência de eventos arrítmicos e o tratamento oferecido durante o seguimento de longo prazo. Métodos: Avaliações retrospectivas de 133 pacientes com CCDC que receberam CDI, principalmente para prevenção secundária. Foram coletados dados demográficos, clínicos e laboratoriais, escore de Rassi e dados do teste de LDF. Adotou-se p<0,05 como estatisticamente significativo. Resultados: A média de idade foi 61±13 anos, e 72% da amostra era do sexo masculino. A fração de ejeção basal do ventrículo esquerdo foi 40±15%, e o escore de Rassi médio foi 10±4 pontos. Não ocorreram óbitos durante o teste de LDF, e não foram documentadas falhas do CDI. Foi identificada relação entre escore de Rassi basal mais elevado e LDFs mais elevados (ANOVA =0,007). O tempo médio até o primeiro choque foi de 474±628 dias, mas a aplicação de choque foi necessária em apenas 28 (35%) pacientes com TV, visto que a maioria dos casos se resolveu espontaneamente ou através da programação de ATP. Após seguimento clínico de 1728±1189 dias, em média, ocorreram 43 óbitos, relacionados principalmente a insuficiência cardíaca progressiva e sepse. Conclusões: Um teste de LDF de rotina pode não ser necessário para pacientes com CCDCs que receberam CDI para prevenção secundária. LDFs elevados parecem ser incomuns e podem estar relacionados a escore de Rassi elevado.

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Electrical Storm in Chagas Cardiomyopathy

Cited by 3 publications

References 15 publications

Chagas Cardiomyopathy: From Romaña Sign to Heart Failure and Sudden Cardiac Death

Chagas Cardiomyopathy: From Romaña Sign to Heart Failure and Sudden Cardiac Death

The imperfect storm: An uncommon presentation of Chagas disease

Teste de Limiar de Desfibrilação e Seguimento a Longo Prazo de Pacientes com Cardiopatia Crônica da Doença de Chagas

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