Abstract

GUTIERREZ PERUCHO¹, Ernesto. Ablación por radiofrecuencia de arritmias por miocardiopatía chagásica. Insuf. card. [online]. 2017, vol.12, n.3, pp.111-114. ISSN 1852-3862.

It is estimated that in patients infected with the parasite Trypanosoma cruzi, 20 to 30% develop myocardial damage (1- 1.2 million in Latin America). Of these, up to 65% may present sudden death without therapeutic intervention. Carlos Chagas himself described this complication 10 years after its discovery. Cardiac arrhythmias, observed mainly in the chronic phase, are benign (isolated monomorphic extrasystoles) when the myocardium is stable, and in its destabilization can develop sustained ventricular tachycardia and ventricular fibrillation. Therapeutic intervention in this type of arrhythmia has been shown to substantially reduce the mortality of this pathology, including pharmacological treatment (amiodarone), implantation of an implantable cardioverter defibrillator (ICD) and radiofrequency ablation (RFA) with an endocardial and epicardial catheter. In studies carried out in Mexico, up to 76% of patients seropositive for Chagas’ disease have developed arrhythmias (48% ventricular and 28% supraventricular). It is noteworthy that 66% of these cases present electrocardiographic signs of subepicardial ischemia. The experience with RFA in arrhythmias due to chagasic cardiomyopathy has already been 20 years, the application of this technique with epicardial approach was initiated in patients with chagasic etiology. The initial successful results of up to 40% have been improved with the new techniques of electroanatomic mapping. Recently, papers have been published that support the utility of RFA to prevent the number of implants and therapies applied with ICDs. It should be noted that the deleterious effect on the ventricular function of RFA has been documented, especially in patients with low ejection fraction.

Keywords : Arrhythmias in Chagas’ disease; Radiofrequency ablation; Chagasic cardiomyopathy; Amiodarone; Implantable cardioverter defibrillator.

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