Advanced Therapies for Ventricular Arrhythmias in Patients With Chagasic Cardiomyopathy: JACC State-of-the-Art Review

Jorge Romero, Alejandro Velasco, Cristiano F. Pisani, Isabella Alviz, David Briceno, Juan Carlos Díaz, Domenico Giovanni Della Rocca, Andrea Natale, Maria de Lourdes Higuchi, Mauricio Scanavacca, Luigi Di Biase

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1225-1242
Number of pages18
JournalJournal of the American College of Cardiology
Volume77
Issue number9
DOIs
StatePublished - Mar 9 2021

Keywords

  • Chagas disease
  • cardiac denervation
  • epicardial ablation
  • nonischemic cardiomyopathy
  • renal denervation
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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