Epicardial Ablation of Ventricular Tachycardia in Chagas Heart Disease

Area of Science:

• Cardiology
• Infectious Diseases
• Electrophysiology

Background:

• Chagas heart disease is a chronic inflammatory cardiomyopathy with diverse clinical presentations.
• Cardiac involvement progresses, leading to cardiomyopathy, arrhythmias, and thromboembolism.
• Chagas ventricular tachycardia is often reentrant and scar-related, with epicardial circuits prevalent in basal inferolateral walls.

Purpose of the Study:

• To investigate the role of epicardial circuits in Chagas ventricular tachycardia.
• To evaluate the efficacy of combined endocardial and epicardial mapping and ablation for Chagas ventricular tachycardia.

Main Methods:

• Cardiac mapping (endocardial and epicardial) to identify VT circuits.
• Radiofrequency ablation targeting identified circuits.
• Analysis of substrate characteristics and ablation outcomes.

Main Results:

• Epicardial circuits are frequently identified as the substrate for Chagas ventricular tachycardia.
• The inferior and lateral basal walls are predominant locations for these circuits.
• Combined endocardial and epicardial ablation strategies show potential for improved outcomes.

Conclusions:

• Epicardial mapping and ablation are crucial for managing Chagas ventricular tachycardia.
• A combined approach may offer better results than conventional endocardial ablation alone.
• Understanding the substrate is key to effective treatment of Chagas cardiomyopathy complications.