TY - JOUR
T1 - Advanced Therapies for Ventricular Arrhythmias in Patients With Chagasic Cardiomyopathy
T2 - JACC State-of-the-Art Review
AU - Romero, Jorge
AU - Velasco, Alejandro
AU - Pisani, Cristiano F.
AU - Alviz, Isabella
AU - Briceno, David
AU - Díaz, Juan Carlos
AU - Della Rocca, Domenico Giovanni
AU - Natale, Andrea
AU - de Lourdes Higuchi, Maria
AU - Scanavacca, Mauricio
AU - Di Biase, Luigi
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/3/9
Y1 - 2021/3/9
N2 - Chagas disease is caused by infection from the protozoan parasite Trypanosoma cruzi. Although it is endemic to Latin America, global migration has led to an increased incidence of Chagas in Europe, Asia, Australia, and North America. Following acute infection, up to 30% of patients will develop chronic Chagas disease, with most patients developing Chagasic cardiomyopathy. Chronic Chagas cardiomyopathy is highly arrhythmogenic, with estimated annual rates of appropriate implantable cardioverter-defibrillator therapies and electrical storm of 25% and 9.1%, respectively. Managing arrhythmias in patients with Chagasic cardiomyopathy is a major challenge for the clinical electrophysiologist, requiring intimate knowledge of cardiac anatomy, advanced training, and expertise. Endocardial-epicardial mapping and ablation strategy is needed to treat arrhythmias in this patient population, owing to the suboptimal long-term success rate of endocardial mapping and ablation alone. We also describe innovative approaches to improve acute and long-term clinical outcomes in patients with refractory ventricular arrhythmias following catheter ablation, such as bilateral cervicothoracic sympathectomy and bilateral renal denervation, among others.
AB - Chagas disease is caused by infection from the protozoan parasite Trypanosoma cruzi. Although it is endemic to Latin America, global migration has led to an increased incidence of Chagas in Europe, Asia, Australia, and North America. Following acute infection, up to 30% of patients will develop chronic Chagas disease, with most patients developing Chagasic cardiomyopathy. Chronic Chagas cardiomyopathy is highly arrhythmogenic, with estimated annual rates of appropriate implantable cardioverter-defibrillator therapies and electrical storm of 25% and 9.1%, respectively. Managing arrhythmias in patients with Chagasic cardiomyopathy is a major challenge for the clinical electrophysiologist, requiring intimate knowledge of cardiac anatomy, advanced training, and expertise. Endocardial-epicardial mapping and ablation strategy is needed to treat arrhythmias in this patient population, owing to the suboptimal long-term success rate of endocardial mapping and ablation alone. We also describe innovative approaches to improve acute and long-term clinical outcomes in patients with refractory ventricular arrhythmias following catheter ablation, such as bilateral cervicothoracic sympathectomy and bilateral renal denervation, among others.
KW - Chagas disease
KW - cardiac denervation
KW - epicardial ablation
KW - nonischemic cardiomyopathy
KW - renal denervation
KW - ventricular tachycardia
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U2 - 10.1016/j.jacc.2020.12.056
DO - 10.1016/j.jacc.2020.12.056
M3 - Review article
C2 - 33663741
AN - SCOPUS:85101362949
SN - 0735-1097
VL - 77
SP - 1225
EP - 1242
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 9
ER -