Long‐term follow‐up of Chagas heart disease patients receiving an implantable cardioverter‐defibrillator for secondary prevention

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

doi:10.1111/pace.13333

Cited by 11 publications

(4 citation statements)

References 23 publications

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“…However, the longterm benefit of ICD use for primary or even secondary prevention remains controversial since no randomized controlled trial to date has tested ICD against pharmacological treatment. One of the reasons for this controversy is the high mortality that patients with CHD present despite ICD implantation 18,[29][30][31] . However, there is great heterogeneity among mortality rates reported after ICD implantation, possibly due to discrepancies in study populations, concomitant use of amiodarone and carvedilol, and ICD programming characteristics.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Three-Dimensional Scar Architecture and Conducting Channels by High-Resolution Contrast-Enhanced Cardiac Magnetic Resonance Imaging in Chagas Heart Disease

Santos

Gottlieb²,

Tassi

et al. 2022

Rev. Soc. Bras. Med. Trop.

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Background:We aimed to describe the morphology of the border zone of viable myocardium surrounded by scarring in patients with Chagas heart disease and study their association with clinical events.Methods: Adult patients with Chagas heart disease (n=22; 55% females; 65.5 years, SD 10.1) were included. Patients underwent high-resolution contrast-enhanced cardiac magnetic resonance using myocardial delayed enhancement with postprocessing analysis to identify the core scar area and border zone channels number, mass, and length. The association between border zone channel parameters and the combined endpoint (cardiovascular mortality or internal cardiac defibrillator implantation) was tested by multivariable Cox proportional hazard regression analyses. The significance level was set at 0.05. Data are presented as the mean (standard deviation [SD]) or median (interquartile range).Results: A total of 44 border zone channels (1[1-3] per patient) were identified. The border zone channel mass per patient was 1.25 (0.48-4.39) g, and the extension in layers of the border zone channels per patient was 2.4 (1.0-4.25). Most border zone channels were identified in the midwall location. Six patients presented the studied end-point during a mean follow-up of 4.9 years (SD 1.6). Border zone channel extension in layers was associated with the studied end-point independent from left ventricular ejection fraction or fibrosis mass (HR=2.03; 95% CI 1.15-3.60). Conclusions:High-resolution contrast-enhanced cardiac magnetic resonance can identify border zone channels in patients with Chagas heart disease. Moreover, border zone channel extension was independently associated with clinical events.

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Section: Discussionmentioning

confidence: 99%

Analysis of Three-Dimensional Scar Architecture and Conducting Channels by High-Resolution Contrast-Enhanced Cardiac Magnetic Resonance Imaging in Chagas Heart Disease

Santos

Gottlieb²,

Tassi

et al. 2022

Rev. Soc. Bras. Med. Trop.

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“…Determining the underlying etiology has a benefit for Chagas cardiomyopathy patients despite the limited efficacy of treatment with antiparasitics (benznidazole and nifurtimox). Patients with Chagas cardiomyopathy might be recommended for heart transplant ( 10 ) and can positively respond to implantable cardioverter-defibrillator placement ( 11 ) and amiodarone ( 12 ). Awareness of infection could lead to testing of at-risk family members who might respond favorably to early treatment.…”

Section: Discussionmentioning

confidence: 99%

Trypanosoma cruzi in Nonischemic Cardiomyopathy Patients, Houston, Texas, USA

Nolan¹,

Aguilar²,

Misra³

et al. 2021

Emerg. Infect. Dis.

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“…14 Entretanto, na prática clínica, esses pacientes também responderão bem à terapia de estimulação antitaquicardia (anti-tachycardia pacing, ATP), com redução da necessidade da aplicação de choques. 15 Dessa forma, investigamos o uso do teste de LDF em pacientes com CCDC, com foco nos óbitos relacionados ao implante do CDI e na ocorrência de eventos arrítmicos e no tratamento oferecido durante o seguimento de longo prazo.…”

Section: Introductionunclassified

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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Long‐term follow‐up of Chagas heart disease patients receiving an implantable cardioverter‐defibrillator for secondary prevention

Abstract: ICDs successfully aborted life-threatening arrhythmias in CHD patients. Impaired left ventricular function predicted higher mortality in CHD patients with an ICD for secondary prevention of SCD.

Cited by 11 publications

References 23 publications

Analysis of Three-Dimensional Scar Architecture and Conducting Channels by High-Resolution Contrast-Enhanced Cardiac Magnetic Resonance Imaging in Chagas Heart Disease

Analysis of Three-Dimensional Scar Architecture and Conducting Channels by High-Resolution Contrast-Enhanced Cardiac Magnetic Resonance Imaging in Chagas Heart Disease

Trypanosoma cruzi in Nonischemic Cardiomyopathy Patients, Houston, Texas, USA

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

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