Ventricular tachycardia in Chagas' disease

Sudden cardiac death in Chagas' heart disease in the contemporary era

“…In fact, Mendoza et al [54] have shown that programmed electrical stimulation was able to reproduce as well as to terminate episodes of sustained VT in 11 (73%) out of 15 patients with Chagas' disease with life-threatening ventricular arrhythmias. Giniger et al [55] compared the outcome of Chagas' disease patients with sustained VT receiving electrophysiologic-guided therapy at programmed electric stimulation with Chagas' disease patients treated with amiodarone empirically over a mean follow up of 56 months. They observed that the mortality rate was lower (15%) in patients treated with electrophysiologic guidance in comparison to patients who were treated empirically with amiodarone at a 10-year follow up (44%, p b 0.05).…”

Sudden death in Chagas' disease

“…According to the authors, the high percentage of torsade de pointes may be explained by the coexistence in Chagas' heart disease of multiple abnormalities, such as disorders of conduction, sinus based on observations, hypotheses, or inference 38,39 . Nevertheless, the essentially arrhythmogenic nature of chronic chagasic heart disease, which is mainly characterized by a high density and complexity of ventricular arrhythmias [40][41][42][43] , its fibrotic character, with akinetic or dyskinetic areas intermingled with preserved myocardial fibers 44,45 , and the reentrant mechanism of sustained ventricular tachycardia in a large number of cases on programmed ventricular stimulation [46][47][48][49] , strongly suggest that ventricular fibrillation constitutes the terminal event in most cases of sudden death in Chagas' disease. Less frequently, a bradyarrhythmia ( sinus (12) CS-cardiac silhouette; CS-cerebral stroke; FC-functional class; CD-Chagas' disease; ECG -electrocardiogram; VEs -ventricular extrasystoles; H -Holter; HFheart failure; CHF-congestive heart failure; mod -moderate; SD -sudden death; NR -not reported; P -patients; XR -chest X-ray; NSVT -nonsustained ventricular tachycardia.…”

“…It is worth noting that reproduction of monomorphic sustained ventricular tachycardia in chronic Chagas' heart disease has been reported in 63 to 95% of the cases [46][47][48][49] . Reentry has been considered the major electrophysiological mechanism, and focal areas of fibrosis or With the inclusion of additional risk predictors, the chagasic population becomes more selective and the risk of sudden death increases gradually.…”

Prognostic Value of Exercise‐Induced Ventricular Arrhythmia in Chagas’ Heart Disease

“…Frequent, complex ventricular premature beats, including runs of ventricular tachycardia (VT), are a common finding on Holter monitoring or exercise testing, 4,5 and they can occur at any stage of the disease. Although the arrhythmia is usually correlated with the severity of ventricular dysfunction, it can also occur in patients with preserved ventricular function 6–10 …”

“…Death in Chagas’ heart disease is frequently sudden, and, in the vast majority of cases, it is caused by either sustained VT degenerating into ventricular fibrillation or by ventricular fibrillation episodes. Moreover, it is well known that left ventricular dysfunction is a common finding in patients with sustained VT associated with Chagas’ heart disease 6–8,10,11 …”