Bestetti Reinaldo B, Cardinalli-Neto Augusto
UNAERP Medical School, 14096-430 Ribeirão Preto, Brazil.
Expert Rev Cardiovasc Ther. 2012 Oct;10(10):1307-17. doi: 10.1586/erc.12.115.
Chagas disease is the principal cause of chronic heart failure in areas where the disease is endemic. The medical treatment is the same recommended for non-Chagas disease patients. There is no evidence-based medicine support for device therapy in Chagas disease heart failure. Cardiac resynchronization therapy is recommended for Chagas disease heart failure patients with intraventricular conduction disturbances, mainly for those with left bundle branch block, and in advanced congestive heart failure refractory to targeted medical treatment, although this therapy is still polemic in Chagas disease heart failure. Implantable cardioverter-defibrillator (ICD) therapy is indicated to Chagas disease patients with left ventricular ejection fraction <30% for primary prevention of sudden cardiac death. ICD therapy is offered to patients for secondary prevention of sudden cardiac death. Patients with moderate left ventricular dysfunction and inducible arrhythmia at electrophysiological testing should receive ICD therapy.
恰加斯病是该病流行地区慢性心力衰竭的主要病因。其药物治疗与非恰加斯病患者的推荐治疗相同。在恰加斯病心力衰竭中，尚无循证医学支持的器械治疗方法。对于伴有室内传导障碍的恰加斯病心力衰竭患者，主要是左束支传导阻滞患者，以及对靶向药物治疗难治的晚期充血性心力衰竭患者，推荐采用心脏再同步治疗，尽管该疗法在恰加斯病心力衰竭中仍存在争议。对于左心室射血分数<30%的恰加斯病患者，植入式心律转复除颤器（ICD）治疗用于心脏性猝死的一级预防。ICD治疗用于心脏性猝死的二级预防。电生理检查显示中度左心室功能障碍且可诱发心律失常的患者应接受ICD治疗。
