Advanced management of ventricular arrhythmias in chronic Chagas cardiomyopathy
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Fecha
2021-12-17Autor(es)
Santacruz, DavidRosas, Fernando
Hardy, Carina Abigail
Ospina, Diego
Rosas, Andrea Nathalie
Camargo, Juan Manuel
Bermúdez, Juan José
Betancourt, Juan Felipe
Velasco, Víctor Manuel
González, Mario D.
Autor(es) Corporativo(s)
Pontificia Universidad Javeriana. Facultad de Medicina. Departamento de Medicina Interna. Cardiología
Tipo
Artículo de revista
ISSN
2666-5018
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Abstract
Chagas cardiomyopathy is a parasitic infection caused by Trypa-nosoma cruzi. Structural and functional abnormalities are the result of direct myocardial damage by the parasite, immunological reactions, dysautonomia, and microvascular alterations. Chronic Chagas cardiomyopathy (CCC) is the most serious and important manifestation of the disease, affecting up to 30% of patients in the chronic phase. It results in heart failure, arrhythmias, thromboembolism, and sudden cardiac death. As in other cardiomyopathies, scar-related reentry frequently results in ventricular tachycardia (VT).
The scars typically are located in the inferior and lateral aspects of the left ventricle close to the mitral annulus extending from
endocardium to epicardium. The scars may be more prominent in the epicardium than in the endocardium, so epicardial mapping
and ablation frequently are required. Identification of late potentials during sinus rhythm and mid-diastolic potentials during
hemodynamically tolerated VT are the main targets for ablation.
High-density mapping during sinus rhythm can identify late isochronal regions that are then targeted for ablation. Preablation
cardiac magnetic resonance imaging with late enhancement can identify potentials areas of arrhythmogenesis. Therapeutic alternatives for VT management include antiarrhythmic drugs and modulation of the cardiac autonomic nervous system.
Keywords
Antiarrhythmic treatmentCardiomyopathy
Catheter ablation
Chagas disease
Endo-epicardial approach
Implantable cardioverter-defibrillator
Neuraxial modulation
Ventricular tachycardia
Enlace al recurso
https://www.heartrhythmopen.com/article/S2666-5018(21)00207-5/fulltext#secsectitle0010Fuente
Heart Rhythm O2; Volumen 2 Número 6, Parte B , Páginas 807 - 818 (2021)
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