VENTRICULAR TACHYCARDIA IN CHRONIC CHAGASIC HEART DISEASE 24-HOUR HOLTER STUDY - CARDIOLOGY SERVICE - HOSPITAL OBRERO DE LA PAZ - BOLIVIA

Abstract

Introduction. – Ventricular tachycardia in chronic Chagas disease has a high mortality rate.

Objectives. – To analyze the frequency, cha- racteristics, mode of onset, ventricular function, progression, and treatment of chronic Chagas di- sease and ventricular tachycardia using 24-hour Holter monitoring.

Methods. – 24-hour Holter monitoring was used in 1,480 patients; 168 (11.3%) had chronic Chagas disease. Ventricular tachycardia was diagnosed by a succession of more than three beats of ventricular origin and a rate greater than 120. Non-sustained ventricular tachycardia was classified if the arrhythmia lasted less than 30 seconds, and sustained if it lasted more than 30 seconds. The onset of ventricular tachycardia, ventricular ejection fraction, treatment, and pa- tient outcomes were analyzed.

Results: Twenty-one patients had ventricular ta- chycardia (12.5%) of the total Chagas patients. The age range was 37–74 years; nine were men and 12 were women. Three had sustained ventricular tachycardia and 18 had nonsustai- ned ventricular tachycardia. Five had torsades de pointes. The ejection fraction was normal in nine patients, five had decreased ventricular ta- chycardia, and four had ventricular tachycardia. The onset of arrhythmia was due to ventricularextrasystoles.

Treatment: Amiodarone in 17 patients, pace- maker implantation associated with various con- comitant conduction disorders in 11, and unk- nown in three. Outcome: 12 were asymptomatic, two had sudden death, one had accidental death, and six had an unknown death.

Conclusion: – Increased incidence of non-sus- tained VT. 9.5% mortality. Ventricular extrasys- toles initiated VT. Treatment: Amiodarone and pacemaker.