Evaluation of patients with implantable cardioverter-defibrillator in a Latin American tertiary center.

INTRODUCTION: Despite advancements in implantable cardioverter-defibrillator (ICD) technology, sudden cardiac death (SCD) remains a persistent public health concern. Chagas disease (ChD), prevalent in Brazil, is associated with increased ventricular tachycardia (VT) and ventricular fibrillation (VF) events and SCD compared to other cardiomyopathies. METHODS: This retrospective observational study included patients who received ICDs between October 2007 and December 2018. The study aims to assess whether mortality and VT/VF events decreased in patients who received ICDs during different time periods (2007-2010, 2011-2014, and 2015-2018). Additionally, it seeks to compare the prognosis of ChD patients with non-ChD patients. Time periods were chosen based on the establishment of the Arrhythmia Service in 2011. The primary outcome was overall mortality, assessed across the entire sample and the three periods. Secondary outcomes included VT/VF events and the combined outcome of death or VT/VF. RESULTS: Of the 885 patients included, 31% had ChD. Among them, 28% died, 14% had VT/VF events, and 37% experienced death and/or VT/VF. Analysis revealed that period 3 (2015-2018) was associated with better death-free survival (p = .007). ChD was the only variable associated with a higher rate of VT/VF events (p < .001) and the combined outcome (p = .009). CONCLUSION: Mortality and combined outcome rates decreased gradually for ICD patients during the periods 2011-2014 and 2015-2018 compared to the initial period (2007-2010). ChD was associated with higher VT/VF events in ICD patients, only in the first two periods.

Ablação e mapeamento eletroanatômico na displasia arritmogênica ventricular / Ablation and electroanatomical mapping in arrhythmogenic right ventricular dysplasia

Alterações estruturais provenientes da displasia arritmogênica ventricular direita criam um importantesubstrato para focos de taquicardias ventriculares por reentrada. Pacientes com alto risco de desenvolverem essasarritmias são submetidos a tratamento farmacológico associado ao uso de cardiodesfibriladores implantáveis.Porém, em casos mais complexos e refratários, nos quais as terapias adequadas pelo cardiodesfibrilador implantávelsão frequentes, uma nova estratégia se fez necessária, visando à diminuição da morbidade desse subgrupo de pacientes.Estudos recentes demonstram que o mapeamento eletroanatômico associado a ablações por radiofrequênciaendocárdica e epicárdica foi eficaz nesse tratamento adjuvante, diminuindo o número de recorrências dastaquicardias ventriculares.

The structural abnormalities caused by arrhythmogenic right ventricular dysplasia create an importantsubstrate for ventricular tachycardia due to anatomic reentry. Patients at high risk of presenting arrhythmias aresubmitted to drug treatment in combination with the use of implantable cardioverter-defibrillators. However, incomplex and refractory cases, in which appropriate implantable cardioverter-defibrillator therapies are frequent,a new strategy is required to decrease the morbidity of this subgroup of patients. Recent studies demonstrate thatelectroanatomical mapping in combination with endocardial and epicardial radiofrequency catheter ablation is aneffective adjuvant therapy and decreases the rate of ventricular tachycardia recurrence.