Sudden Cardiac Death in Chagas Disease

Dario Di Toro, Adrian Baranchuk

Abstract


Chagas’ disease remains a major epidemiologic problem in endemic countries. The most dramatic course of the disease is represented by sudden cardiac death. Some of these deaths could be preventable, if efforts are directed towards identifying high-risk patients. Implantable cardioverter-defibrillators are an effective treatment for the prevention of sudden cardiac arrhythmic death, however; its costs are the major limitation for their widespread use in the endemic region.

This review will cover some of the most relevant aspects of sudden cardiac death in Chagas’ disease. 


Keywords


Chagas’ disease; Sudden Death; Ventricular Tachycardia

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References


Priori S, Blomström-Lundqvist C, Mazzanti A , Blom N, Borggrefe N, Camm J, et al 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC) Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). European Heart Journal 2015 36, 2793–2867 doi:10.1093/eurheartj/ehv316

Rassi A Jr, Rassi A,Rassi SG. Predictors of Mortality in Chronic Chagas Disease A Systematic Review of Observational Studies. Circulation. 2007;115: 1101-1108. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.627265.

Moncayo A, Silveira AC. Current epidemiological trends for Chagas disease in Latin America and future challenges in epidemiology, surveillance and health policy. Mem Inst Oswaldo Cruz, Rio de Janeiro, 2009 Vol. 104 (Suppl. I): 17-30. http://dx.doi.org/10.1590/S0074-02762009000900005.

Braggion-Santos MF, Jardim Volpe G, Pazin-Filho A, Maciel BC, Marin-Neto JA, Schmidt A .Sudden Cardiac Death in Brazil: A Community-Based Autopsy Series (2006-2010) Arq Bras Cardiol. 2015; 104(2):120-127. doi: 10.5935/abc.20140178.

Rassi A Jr, Rassi SG, Rassi A. Sudden Death in Chagas ‘disease. Arq. Bras. Cardiol.2001 vol.76 n.1 São Paulo http://dx.doi.org/10.1590/S0066-782X2001000100008

Lopes ER, Cunha LFLR, Santos TAM. Variações circadianas diárias e semanais na morte súbita da Doença de Chagas. Arq Bras Cardiol 1993; 61: 345-8. http://dx.doi.org/10.1590/S0066-782X2007000200017.

Andrade Z, Lopes ER, Prata SP. Alterações do sistema de condução do coração emchagásicos acometidos de morte repentina. Arq Bras Cardiol 1987; 48: 5-9.

Mendoza I, Moleiro F, Marques J. Morte súbita na doença de Chagas. Arq Bras Cardiol 1992; 59: 3-4.

Bestetti RB, Freitas OC, Muccillo G, Oliveira JSM. Clinical and morphological characteristics associated with sudden cardiac death in patients with Chagas' disease.

Eur Heart J 1993; 14: 1610–4. http://dx.doi.org/10.1093/eurheartj/14.12.1610

Arce M, VAN Grieken J, Femenía F, Arrieta M, McIntyre WF, Baranchuk A. Permanent pacing in patients with Chagas' disease. Pacing Clin Electrophysiol. 2012 35 (12):1494-7. doi: 10.1111/pace.12013.

Cardinalli-Neto A, Greco OT, Bestetti RB. Automatic implantable cardioverter-defi brillators in Chagas' heart disease patients with malignant ventricular arrhythmias. Pacing Clin Electrophysiol 2006; 29:467-470. DOI: 10.1111/j.1540-8159.2006.00377.x

Di Toro D, Muratore C, Aguinaga L, Batista L, Malan S, Greco O, et al Predictors of All-Cause 1-Year Mortality in Implantable Cardioverter Defibrillator Patients with Chronic Chagas’ Cardiomyopathy. Pacing Clin Electrophysiol 2011;34:1063–1069. DOI: 10.1111/j.1540-8159.2011.03108.x

de Paola AAV, Horowitz LN, Miyamoto F, Pinheiro R, Ferreira D, Terzian AB et al. Angiographic and electrophysiologic substrates of ventricular tachycardia in chronic chagasic myocarditis. Am J Cardiol 1990;65: 360–3 doi:10.1016/0002-9149(90)90302-H

Junqueira LF. Sobre o possível papel da disfunção autonômica cardíaca na morte súbita associada à doença de Chagas. Arq Bras Cardiol 1991; 56: 420–34.

Barretto AC, Arteaga E, Mady C, Ianni BM, Bellotti G, Pileggi F.

Male sex .Prognostic factor in Chagas’ disease. Arq. Bras. Cardiol. 1993 60(4), 225–227.

Basquiera AL, Sembaj A, Aguerri AM et al. Risk progression to chronic Chagas

Cardiomyopathy: influence of male sex and of parasitaemia detected by polymerase chain reaction. Heart 2003 89(10), 1186–1190. doi:10.1136/heart.89.10.1186

Rassi A Jr, Rassi A, Little WC, Xavier SS, Rassi SG, Rassi AG, et al. Development and validation of a risk score for predicting death in Chagas’ heart disease. N. Engl. J. Med.2006 355(8), 799–808. DOI: 10.1056/NEJMoa053241

Rodriguez-Salas LA, Klein E, Acquatella H Catalioti F, Davalos V, Gomez-Mancebo JR. et al. Echocardiographic and clinical predictors of mortality in chronic Chagas’ disease. Echocardiography 1998 15(3), 271–278 DOI: 10.1111/j.1540-8175.1998.tb00607.x

Espinosa RA, Pericchi LR, Carrasco HA, Escalante A, Martínez O, González R.

Prognostic indicators of chronic Chagasic cardiopathy. Int. J. Cardiol. 1991 30(2),

–202 doi: 10.1016/0167-5273(91)90095-7.

Salles G, Xavier S, Sousa A, Hasslocher-Moreno A, Cardoso C. Prognostic value of QT interval parameters for mortality risk stratification in Chagas’ disease: results of a long-term follow-up study. Circulation 2003 108 (3), 305–312.

doi: 10.1161/01.CIR.0000079174.13444.9C

Baranchuk A, Miranda R, Femenía F; FECHA Investigators. Chagas' cardiomyopathy and Fragmented QRS. Re: QRS fragmentation as a marker of arrhythmias in coronary artery disease, in cardiomyopathies and ion channel diseases. Int J Cardiol. 2012 Oct 4; 160 (2):151-2.

Rodriguez C, Baranchuk A, Femenia F, Lopez-Diez JC, Muratore C, Valentino M, Retyk E, Galizio N, Di Toro D, Alonso K. Fragmented Surface ECG Was a Poor Predictor of Appropriate Therapies in Patients with Chagas’ Cardiomyopathy and ICD Implantation Ann Noninvasive Electrocardiol 2013;00(0):1–7. DOI:10.1111/anec.12077

Rassi Jr A, Rassi AG, Rassi SG, Rassi Jr L, Rassi A. Relação entre sintomas, disfunção ventricular e arritmia ventricular na cardiopatia chagásica crônica. Arq Bras Cardiol 1992; 59(supl II): 182

Pedrosa RC, Salles JH, Magnanini MM, Bezerra DC, Bloch KV. Prognostic value of exercise-induced ventricular arrhythmia in Chagas’ heart disease. Pacing Clin.Electrophysiol.2011 34 (11), 1492–1497. DOI: 10.1111/j.1540-8159.2011.03171.x

Viotti RJ, Vigliano C, Laucella S, Lococo B, Petti M, Bertocchi G et al. Value of echocardiography for diagnosis and prognosis of chronic Chagas disease cardiomyopathy without heart failure. Heart 2004 90(6), 655–660. doi: 10.1136/hrt.2003.018960

Sternick E, Martinelli M, Sampaio R ,Gerken LM, Teixeira RA, Scarpelli R et al. Sudden Cardiac Death in Patients with Chagas Heart Disease and Preserved Left Ventricular Function. J Cardiovasc Electrophysiol 2006; 17: 113-116. doi: 10.1111/j.1540-8167.2005.00315.

Nunes Mdo C, Rocha MO, Ribeiro AL, Colosimo EA, Rezende RA, Carmo GA .et al. Right ventricular dysfunction is an independent predictor of survival in patients with dilated chronic Chagas’cardiomyopathy. Int. J. Cardiol .2008 127(3), 372 -379.DOI: http://dx.doi.org/10.1016/j.ijcard.2007.06.012

Viotti R, Vigliano C, Lococo B, Petti M, Bertocchi G, Alvarez MG et al. Clinical predictors of chronic Chagasic myocarditis progression. Rev. Esp. Cardiol.2005 58 (9), 1037–1044. DOI: 10.1157/13078551

Ribeiro AL, Cavalvanti PS, Lombardi F, Nunes Mdo C, Barros MV, Rocha MO. Prognostic value of signal-averaged electrocardiogram in Chagas disease. J Cardiovasc. Electrophysiol 2008 19(5): 502–509 DOI: 10.1111/j.1540-8167.2007.01088.

Rosenbaum M, Posse R, Sgammini H, Núñez Burgos J, Chiale PA, Pastori JD, et al. Comparative multicenter clinical study of flecainide and amiodarone in the treatment of ventricular arrhythmias associated with chronic Chagas cardiopathy. Arch Inst Cardiol Mex

; 57: 325-330.

Epstein AE, Di Marco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:350-408.

doi: 10.1161/CIRCUALTIONAHA.108.189742

Ministério da Saúde. Secretaria de Atenção à Saúde. Portaria 152 de 08 de março de 2007. Diário Ofi cial 8-3-2007. Brasília: Ministério da Saúde; 2007

Cardinalli-Neto A, Bestetti RB, Cordeiro JA, Rodrigues VC. Predictors of all-cause mortality for patients with chronic Chagas' heart disease receiving implantable cardioverter defi brillator therapy. J Cardiovasc Electrophysiol 2007; 18:1236-1240. DOI: 10.1111/j.1540-8167.2007.00954.x

Muratore CA, Batista Sa LA, Chiale PA, Eloy R, Tentori MC, Escudero J, et al. Implantable cardioverter defi brillators and Chagas' disease: results of the ICD Registry Latin America. Europace 2009;11: 164-168 doi:10.1093/europace/eun391

Martinelli Filho M, De Siqueira SF, Moreira H, Fagundes A,Pedrosa A, Nishioka SD, et al. Probability of occurrence of life threatening ventricular arrhythmias in Chagas' disease versus non- Chagas' disease. Pacing Clin Electrophysiol 2000; 23:1944-1946. DOI: 10.1111/j.1540-8159.2000.tb07058.x

Barbosa MP, da Costa Rocha MO, de Oliveira AB, Lombardi F, Ribeiro AL. Efficacy and safety of implantable cardioverter defibrillators in patients with Chagas disease, Europace 2013; 15: 957-962. doi: 10.1093/europace/eut011.

St John Sutton MG, Plappert T, Abraham WT, Smith A L, DeLurgio DB , Leon AR et al. Effect of cardiac resynchronization on left ventricular size and function in chronic heart failure. Circulation.2003; 107: 1985–1990. doi: 10.1161/01.CIR.0000065226.24159.E9

Abraham WT, Young JB, León AR, Adler S, Bank AJ, Hall SA, et al. Effects of cardiac resynchronization on disease progression in patients with left ventricular systolic dysfunction, an indication for implantable cardioverter-defibrillator, and mildly symptomatic chronic heart failure. Circulation. 2004; 110 : 2864–2868. doi: 10.1161/01.CIR.0000146336.92331.D1

Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med.2004; 350: 2140–2150. DOI: 10.1056/NEJMoa032423.

Cleland JGF, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005; 352: 1539–1549. DOI: 10.1056/NEJMoa050496

Muratore CA, Baranchuk A. Current and emerging therapeutic options for the treatment of chronic chagasic cardiomyopathy. Vasc Health Risk Manag. 2010 9;6:593-601.

Kutyifa V, Stockburger M, Daubert JP, Holmqvist F, Olshansky B, Schuger C, Klein H, et al .PR interval identifies clinical response in patients with non-left bundle branch block: a Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy substudy Circ Arrhythm Electrophysiol. 2014 Aug;7(4):645-51. doi: 10.1161/CIRCEP.113.001299.

Tompkins C, Kutyifa V, McNitt S, Polonsky B, Klein HU, Moss AJ, Zareba W.

Effect on cardiac function of cardiac resynchronization therapy in patients with right bundle branch block (from the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy [MADIT-CRT] trial). Am J Cardiol. 2013 Aug 15;112(4):525-9. doi: 10.1016/j.amjcard.2013.04.016

Ferreira de Araújo E; Gregório Chamlian E, Pomares Peroni A, Lopes Pereira; Matheus de Aquino Gandra S , Antonio Rivetti L. Cardiac resynchronization therapy in patients with chronic Chagas cardiomyopathy: long-term follow up. Rev Bras Cir Cardiovasc 2014; 29 (1):31-6 DOI: 10.5935/1678-9741.20140008

Vilas-Boas F, Feitosa GS, Soares MB, Mota A, Alves Pinho-Filho J , Gonçalves Almeida A et al. Early results of bone marrow cell transplantation to the myocardium of patients with heart failure due to Chagas disease. Arq Bras Cardiol. 2006; 87: 159–166. dx.doi.org/10.1590/S0066-782X2006001500014.

Trainini JC, Barisani JL, Lago N, et al. Resultados alejados del implante miocárdico de células madre en la miocardiopatía chagásica. Rev Argent Cardiol. 2007; 75 : 257–263.

Aaronson KD, Schwartz JS, Chen TM, Wong KL, Goin JE, Mancini DM

Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation.

Circulation 1997; 95:2660–2667. http://dx.doi.org/10.1161/01.CIR.95.12.2660

Mehra NR, Kobashigawa J, Starling R, Russell S, Uber PA, Parameshwar J et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates 2006.J Heart Lung Transplant. 2006;25: 1024 – 1042. http://dx.doi.org/10.1016/j.healun.2006.06.008

Franciosa JA, Wilen M, Ziesche S, Cohn JN. Survival in men with severe chronic left ventricular failure due to either coronary heart disease or idiopathic dilated cardiomyopathy. Am J Cardiol. 1983; 51: 831–836. http://dx.doi.org/10.1016/S0002-9149(83)80141-6

Wilson JR, Schwartz JS, St John Sutton M, Ferraro N, Horowitz LN, Reichek N, et al. Prognosis in severe heart failure: relation to hemodynamic measurements and ventricular ectopic activity. J Am Coll Cardiol. 1983; 2: 403–410.

Fuster V, Gersh BJ, Giuliani ER, Tajik AJ, Brandenburg RO, Frye RL. The natural history of idiopathic dilated cardiomyopathy. Am J Cardiol. 1981; 47: 525–531.

Bertolino ND, Villafanha DF, Cardinalli-Neto A, Cordeiro JA, Arcanjo M , Theodoropoulos TA, et al. Prognostic impact of Chagas’ disease in patients awaiting heart transplantation. J Heart Lung Transplant. 2010; 29(4):449–453. doi: 10.1016/j.healun.2009.10.014

Dib JA, Bestetti RB, Freitas PF, Theodoropoulos TA, Cardinalli-Neto A, Cordeiro JA. Predictors of all-cause mortality for patients with Chagas’ cardiomyopathy listed for heart transplantation. Int J Cardiol. 2009; 136 (2):162–164. doi: 10.1016/j.ijcard.2008.04.034

Shewan LG, Coats AJS, Henein M. Requirements for ethical publishing in

biomedical journals. International Cardiovascular Forum Journal 2015;2:2 DOI: 10.17987/icfj.v2i1.4




DOI: https://doi.org/10.17987/icfj.v7i0.302

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