Abstract
ABSTRACTObjective:Chagas disease has become a global problem due to changing migration patterns. An electrophysiological study is generally indicated for assessing sinus node function, conduction through the atrioventricular node and His-Purkinje system, in addition to evaluating the mechanisms of arrhythmia. The aim of this study was to describe the characteristics of electrophysiological study findings in patients with Chagas disease.Methods:A retrospective descriptive study of 115 consecutive patients with Chagas disease undergoing an electrophysiological study over the last three years in a tertiary hospital in Brazil. Baseline characteristics, electrocardiogram, echocardiogram, and 24-hour Holter monitoring findings were recorded and correlated with the electrophysiological study findings.Results:The corrected sinus node recovery time and sinoatrial conduction time were abnormal in 6.9% and 26.1% of patients, respectively. Thirty-seven (32.2%) had abnormal atrioventricular conduction. Intraventricular conduction was abnormal in 39 (33.9%). Approximately 48% had induced sustained ventricular arrhythmias, most of which were monomorphic (83.6%). Right bundle branch block was the most common morphology (52.7%). Fifty-one percent were associated with symptoms/hemodynamic instability, 60% required electrical cardioversion, and 27.3% needed overdrive suppression. The most common site of origin was the left ventricular inferoseptal wall (18.2%), followed by the left ventricular posterobasal wall (11%). Patients with an ejection fraction<40% had a 1.94-fold increased risk of ventricular arrhythmias compared to those with an ejection fraction>60% (OR: 1.94; 95%CI: 1.12-3.38; p=0.01). The presence of complex ventricular arrhythmias on Holter did not predict inducible ventricular arrhythmias.Conclusions:Chagas patients with a low ejection fraction have an increased risk of inducible ventricular arrhythmias. Sinus node dysfunction, and atrioventricular node and His-Purkinje conduction abnormalities occur in about one-third of patients. Complex ventricular arrhythmias on Holter were not associated with an increased risk of inducible ventricular arrhythmias.
Highlights
Chagas disease (CD) has become a global problem due to changing migration patterns[1,2]
Electrophysiological testing is generally indicated for the assessment of sinus node function, conduction through the atrioventricular node and His-Purkinje system, and evaluation of the mechanisms of arrhythmia
More than 50% of patients were on angiotensin converting enzyme inhibitor (ACEI) or angiotensin II
Summary
Chagas disease (CD) has become a global problem due to changing migration patterns[1,2]. 13 million people are affected by CD both in endemic and non-endemic countries[3]. 20 to 30% of patients with CD in the so-called indeterminate stage will progress to over cardiomyopathy and develop arrhythmic and/or cardiomyopathic complications, manifested clinically by palpitations, dizziness, syncope, heart failure, and sudden death[4,5]. Chronic inflammation usually triggered by parasite persistence may lead to fibrosis and result in sinus node dysfunction, atrioventricular and intraventricular conduction abnormalities, and ventricular tachyarrhythmias due to reentry[6,7]. The adequate assessment of patients with CD involves the use of supplementary methods to investigate atrial and ventricular arrhythmias[5]. Electrophysiological testing is generally indicated for the assessment of sinus node function, conduction through the atrioventricular node and His-Purkinje system, and evaluation of the mechanisms of arrhythmia
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