Frequent electrocardiographic abnormalities and associated conditions in Chagas disease patients

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Purpose: Chagas disease (ChD) is endemic in Latin American countries, but has become a worldwide problem due to migration of infected individuals to developed countries, mostly in Europe and North America. Electrocardiography has been considered an essential exam to evaluate ChD patients. The objective of this study was to identify prevalent abnormalities in the electrocardiogram (ECG) and common associated conditions in patients with ChD. Methods: In this observational and retrospective study, all 12-lead standard digital electrocardiograms (ECGs) analyzed by cardiologists of a public telemedicine service in Brazil, from January to December 2011 were assessed. This service attends primary care of 658 cities in Minas Gerais province. ECGs were sent by remote professionals through internet to be analyzed by cardiologists who are trained and experienced in the analysis and interpretation of ECG. The prevalence of ECG abnormalities in patients who declared to have ChD was assessed. Results: During the study period, 264,324 patients were evaluated; 7590 were ChD patients (mean age 57.0±13.7 years, 64.1% women. Hypertension was the most frequent comorbidity, present in 61.3% of the ChD patients, followed by diabetes (9.1%) and dyslipidemia (6.9%). Family history of coronary disease was reported by 32.6% of the patients, and 10.7% referred smoking. Only 30.1% of the patients had normal ECGs. Regarding the rhythm, 86.9% of them had a normal sinus rhythm, 5.3% atrial fibrillation or flutter, 5.4% ventricular premature beats, 2.5% supraventricular premature beats and 3.5% were pacemaker users. Right bundle branch block (RBBB) was observed in 22.7% of the ECGs, left bundle block in 3.1% and left anterior hemiblock (LAH) in 22.5%.The presence of first degree atrioventricular block was found in 4.9%, second and third degrees in 0.2% each. There was electrocardiographic evidence of left ventricular and atrial hypertrophy in 3.6% and 2.5% of patients, respectively. Conclusion: In this large sample of primary care patients with ChD, there was a high prevalence of ECG abnormalities. As expected, the most common abnormalities were RBBB and LAH.