Transcoronary chemical ablation of ventricular tachycardia in chronic chagasic myocarditis.

OBJECTIVE: A case of incessant ventricular tachycardia in a patient with Chagas' disease that was successfully terminated by chemical ablation is reported. BACKGROUND: Chagas' disease is a common medical problem in South America. Ventricular tachyarrhythmias, atrioventricular conduction disturbances, congestive heart failure and sudden cardiac death are important manifestations of this disease. METHODS: Selective catheterization of the coronary artery supplying the arrhythmogenic area was performed by using a conventional angioplasty system and the arrhythmogenic area was ablated by injection of 96% sterile ethanol. RESULTS: Ethanol (96%) injection initially in a lateral branch of the left circumflex artery and 2 days later in the proximal segment of the artery resulted in termination of ventricular tachycardia. Two weeks after ablation, programmed ventricular stimulation failed to induce ventricular tachycardia. CONCLUSION: Transcoronary chemical ablation should be considered in selected cases of Chagas' disease with incessant ventricular tachycardia.

Ventricular tachycardia during exercise testing as a predictor of sudden death in patients with chronic chagasic cardiomyopathy and ventricular arrhythmias.

OBJECTIVE: To verify the prognostic value of exercise induced ventricular arrhythmias in patients with chagasic cardiomyopathy. METHODS: 69 consecutive patients (37 male, 32 female; age range 21-67 years) with chronic chagasic cardiomyopathy and ventricular arrhythmias (more than 10 ventricular premature complexes per hour) were evaluated during treadmill exercise testing, using the Bruce protocol. Protocol end points were peak heart rate or presence of sustained ventricular tachycardia. MAIN OUTCOME MEASURE: Sudden cardiac death. RESULTS: 44 patients (group I) developed ventricular tachycardia during exercise testing (five sustained and 39 non-sustained), and 25 did not (group II). After a follow up of 24 (SD 15) months sudden cardiac death occurred in seven patients in group I and in none in group II (P < 0.05). CONCLUSIONS: Ventricular tachycardia on exercise testing is significantly associated with sudden cardiac death in patients with chronic chagasic cardiomyopathy and ventricular arrhythmias.