Simultaneous epicardial and endocardial substrate mapping and radiofrequency catheter ablation as first-line treatment for ventricular tachycardia and frequent ICD shocks in chronic chagasic cardiomyopathy

Abstract

Chronic Chagas cardiomyopathy patients have larger epicardial as compared to endocardial substrate areas. Combined epicardial endocardial substrate mapping and ablation during sinus rhythm proves effective in preventing VT recurrences and appropriate ICD therapies.

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

“…Arrhythmias and conduction disorders can occur in both the acute phase and CCC 28,198 . The acute phase is usually asymptomatic, but, similarly to other types of myocarditis, arrhythmias and AVB can occur during the acute infection, being markers of poor prognosis 28 .…”

“…The acute phase is usually asymptomatic, but, similarly to other types of myocarditis, arrhythmias and AVB can occur during the acute infection, being markers of poor prognosis 28 . Most arrhythmias and conduction disorders occur during the chronic phase, being direct consequences of the chronic fibrosing myocarditis triggered by T. cruzi 28,198 , with formation of scars and aneurysms 24,28,198 . Those myocardial scars, focal or scattered spread across the ventricles, contribute to the genesis of reentry ventricular arrhythmias [199][200][201] .…”

“…Those myocardial scars, focal or scattered spread across the ventricles, contribute to the genesis of reentry ventricular arrhythmias [199][200][201] . In addition, the cardiac excito-conduction tissue is frequently damaged, leading to sinus node dysfunction and disorders of the atrioventricular and intraventricular conduction 28,198 . In addition to the repairing and reacting fibrosis, damage to the cardiac nervous endings, especially the parasympathetic ones, occurs, a phenomenon that has been associated with an increase in the number of ventricular ectopies, myocardial electrical instability and SD in patients with CCC 24,28,198 .…”

“…In addition, the cardiac excito-conduction tissue is frequently damaged, leading to sinus node dysfunction and disorders of the atrioventricular and intraventricular conduction 28,198 . In addition to the repairing and reacting fibrosis, damage to the cardiac nervous endings, especially the parasympathetic ones, occurs, a phenomenon that has been associated with an increase in the number of ventricular ectopies, myocardial electrical instability and SD in patients with CCC 24,28,198 . Changes in the density and function of connexins could also contribute to the genesis of arrhythmias and conduction disorders present in the disease 202 .…”

“…Ventricular arrhythmias are the most frequent and can manifest as isolated ectopies or repetitive forms 206 . The SVT is the most common potentially fatal reentry arrhythmia in patients with CCC and segmentary contractile changes, even when the global systolic function is preserved 24,28,[198][199][200] . The arrhythmogenic substrate of that disease is complex, with LV subendocardial, transmural and epicardial scars, which can also affect the right ventricle 200,[201][202][203][204][205][206][207] .…”