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

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:77

Review

Romero, Jorge¹  Velasco, Alejandro¹  Pisani, Cristiano F.²  Alviz, Isabella¹  Briceno, David¹  Diaz, Juan Carlos¹  Della Rocca, Domenico Giovanni³  Natale, Andrea^1,3  Higuchi, Maria de Lourdes²  Scanavacca, Mauricio²  Di Biase, Luigi^1,3 

[1] Albert Einstein Coll Med, Montefiore Einstein Ctr Heart & Vasc Care, Cardiac Arrhythmia Ctr, Div Cardiol,Dept Med, New York, NY USA

[2] Univ Sao Paulo, Heart Inst InCor, Arrhythmia Unit, Med Sch, Sao Paulo, Brazil

[3] St Davids Med Ctr, Texas Cardiac Arrhythmia Inst, Austin, TX USA

关键词: cardiac denervation;    Chagas disease;    epicardial ablation;    nonischemic cardiomyopathy;    renal denervation;    ventricular tachycardia;   

DOI  :  10.1016/j.jacc.2020.12.056

来源: Elsevier

【 摘 要 】

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. (c) 2021 by the American College of Cardiology Foundation.

【 授权许可】

Free