Barbosa Marco Paulo Tomaz, Carmo Andre Assis Lopes do, Rocha Manoel Otávio da Costa, Ribeiro Antonio Luiz Pinho
Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Rev Soc Bras Med Trop. 2015 Jan-Feb;48(1):4-10. doi: 10.1590/0037-8682-0003-2014. Epub 2015 Feb 13.
Sudden death is one of the most characteristic phenomena of Chagas disease, and approximately one-third of infected patients develop life-threatening heart disease, including malignant ventricular arrhythmias. Fibrotic lesions secondary to chronic cardiomyopathy produce arrhythmogenic substrates that lead to the appearance and maintenance of ventricular arrhythmias. The objective of this study is to discuss the main clinical and epidemiological aspects of ventricular arrhythmias in Chagas disease, the specific workups and treatments for these abnormalities, and the breakthroughs needed to determine a more effective approach to these arrhythmias. A literature review was performed via a search of the PubMed database from 1965 to May 31, 2014 for studies of patients with Chagas disease. Clinical management of patients with chronic Chagas disease begins with proper clinical stratification and the identification of individuals at a higher risk of sudden cardiac death. Once a patient develops malignant ventricular arrhythmia, the therapeutic approach aims to prevent the recurrence of arrhythmias and sudden cardiac death by the use of implantable cardioverter defibrillators, antiarrhythmic drugs, or both. In select cases, invasive ablation of the reentrant circuit causing tachycardia may be useful. Ventricular arrhythmias are important manifestations of Chagas cardiomyopathy. This review highlights the absence of high-quality evidence regarding the treatment of ventricular arrhythmias in Chagas disease. Recognizing high-risk patients who require specific therapies, especially invasive procedures such as the implantation of cardioverter defibrillators and ablative approaches, is a major challenge in clinical practice.
猝死是恰加斯病最典型的现象之一，约三分之一的感染患者会发展为危及生命的心脏病，包括恶性室性心律失常。慢性心肌病继发的纤维化病变会产生致心律失常基质，导致室性心律失常的出现和维持。本研究的目的是探讨恰加斯病室性心律失常的主要临床和流行病学方面、针对这些异常情况的具体检查和治疗方法，以及确定更有效治疗这些心律失常方法所需的突破。通过检索1965年至2014年5月31日的PubMed数据库，对恰加斯病患者的研究进行了文献综述。慢性恰加斯病患者的临床管理始于适当的临床分层和识别心脏性猝死风险较高的个体。一旦患者发生恶性室性心律失常，治疗方法旨在通过使用植入式心脏复律除颤器、抗心律失常药物或两者兼用来预防心律失常复发和心脏性猝死。在某些情况下，对导致心动过速的折返环路进行侵入性消融可能会有用。室性心律失常是恰加斯心肌病的重要表现。本综述强调了缺乏关于恰加斯病室性心律失常治疗的高质量证据。识别需要特定治疗的高危患者，尤其是侵入性手术，如植入心脏复律除颤器和消融方法，是临床实践中的一项重大挑战。
