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Advanced management of ventricular arrhythmias in chronic Chagas cardiomyopathy

David Santacruz1,2, Fernando Rosas1,2, Carina Abigail Hardy3

  • 1Department of Cardiac Electrophysiology, Fundación Clínica Shaio, Bogotá, Colombia.

Heart Rhythm O2
|January 6, 2022
PubMed

Insights

Chagas cardiomyopathy, caused by Trypanosoma cruzi, leads to heart failure and sudden death. Epicardial mapping and ablation are key for managing scar-related ventricular tachycardia in chronic Chagas cardiomyopathy.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Imaging

Background:

  • Chagas cardiomyopathy results from Trypanosoma cruzi infection, causing myocardial damage, immune reactions, and autonomic dysfunction.
  • Chronic Chagas cardiomyopathy (CCC) affects up to 30% of patients, leading to severe outcomes like heart failure, arrhythmias, and sudden cardiac death.
  • Ventricular tachycardia (VT) in CCC is often caused by scar-related reentry, typically located in the inferior/lateral left ventricle.

Purpose of the Study:

  • To review the pathophysiology and management of ventricular tachycardia in Chagas cardiomyopathy.
  • To highlight the role of epicardial mapping and ablation in treating scar-related VT.
  • To discuss diagnostic tools and therapeutic alternatives for VT in CCC.

Main Methods:

  • Review of literature on Chagas cardiomyopathy, VT, and ablation techniques.
  • Analysis of scar location and characteristics using imaging (cardiac MRI) and electrophysiological mapping.
  • Discussion of ablation targets, including late potentials and isochronal regions.

Main Results:

  • Scar tissue in CCC is often transmural and may be more prominent epicardially, necessitating epicardial mapping and ablation.
  • Late potentials during sinus rhythm and mid-diastolic potentials during VT are critical targets for successful ablation.
  • High-density mapping and preablation cardiac MRI with late enhancement aid in identifying arrhythmogenic substrates.

Conclusions:

  • Epicardial mapping and ablation are frequently required for managing ventricular tachycardia in Chagas cardiomyopathy due to scar location and characteristics.
  • Targeting specific electrophysiological findings during mapping is crucial for effective VT ablation.
  • Management of VT in CCC involves a combination of antiarrhythmic drugs, autonomic modulation, and interventional procedures.

Keywords:
Antiarrhythmic treatmentCardiomyopathyCatheter ablationChagas diseaseEndo-epicardial approachImplantable cardioverter-defibrillatorNeuraxial modulationVentricular tachycardia

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