16-46: Ten year follow up of a Chagasic cohort with implanted cardiac pacemakers. Single center experience

Abstract

Introduction: It is well known that patients (p) with chagasic cardiomyopathy have an increased risk of conduction disturbances, ventricular arrhythmia and myocardial dysfunction. The aim of this study was to assess long term evolution of p with Chagas disease implanted with a pacemaker (PM). Methods: Retrospective study that included 180 consecutive patients. Left ventricular diastolic (LVDD) and left atrial (LAD) dimensions by echocardiography at the moment of the implant and at the end of follow up were compared .We analized causes of death, atrial and ventricular arrythmias, development of ventricular dysfunction and indications of CRT and CDI during follow up. Results: We included 180 p with a mean age of 51 ± 14 at the moment of PM implant with a mean follow up of 176 months (range 12-499 months). We lost 70 p during follow up. PM indications were : sick sinus síndrome (SSS) 31% (more prevalent in females 43,8% vs. 15.9%, p 0.001), complete AV block 41%, low rate atrial fibrillation (AF) 8.3%, binodal disease 1.8%. The mayority of PM were dual chamber (81%). Twenty two p (12%) had AF prior to PM implant and 46 p (25%) developed new AF during follow up (10 p paroxismal and 36 p permanent). There were no statistical differences between LVDD and LAD at the moment of PM implant and at the end of follow up, (LVDD 54 ± 40 vs 55 ± 21 mm, p = 0.1; LAD 42 ± 30 vs. 43 ± 21 mm p= 0.5) although patients who developed AF had a slightly larger LAD tan those who do not (46 ± 9 vs. 42 ± 7 mm, p 0.04). Twenty five p (13%) died during follow up: 8 p (7%) of sudden cardiac death and 16 (8%) of cardiac failure progression. One p required an up grade to an CRTD and died of a non cardiac cause one year after implant. Nine p (8%) requiered an ICD up grade: 2 p as a primary prevention and 7 p as a secondary prevention. Conclusions: In ten year follow up of chagasic p with a PM we observated that AV block is the most common PM indication, the progression to dilated cardiomyopathy is very slow, hihg incidence of new AF and malignant arrythmias that require an ICD implant.