ABSTRACT
Chagas disease is caused by infection from the protozoan parasite Trypanosoma cruzi. Although it is endemic to Latin America, global migration has led to an increased incidence of Chagas in Europe, Asia, Australia, and North America. Following acute infection, up to 30% of patients will develop chronic Chagas disease, with most patients developing Chagasic cardiomyopathy. Chronic Chagas cardiomyopathy is highly arrhythmogenic, with estimated annual rates of appropriate implantable cardioverter-defibrillator therapies and electrical storm of 25% and 9.1%, respectively. Managing arrhythmias in patients with Chagasic cardiomyopathy is a major challenge for the clinical electrophysiologist, requiring intimate knowledge of cardiac anatomy, advanced training, and expertise. Endocardial-epicardial mapping and ablation strategy is needed to treat arrhythmias in this patient population, owing to the suboptimal long-term success rate of endocardial mapping and ablation alone. We also describe innovative approaches to improve acute and long-term clinical outcomes in patients with refractory ventricular arrhythmias following catheter ablation, such as bilateral cervicothoracic sympathectomy and bilateral renal denervation, among others.
Subject(s)
Autonomic Denervation/trends , Catheter Ablation/trends , Chagas Cardiomyopathy/epidemiology , Chagas Cardiomyopathy/therapy , Tachycardia, Ventricular/epidemiology , Tachycardia, Ventricular/therapy , Autonomic Denervation/methods , Catheter Ablation/methods , Chagas Cardiomyopathy/diagnostic imaging , Defibrillators, Implantable/trends , Epicardial Mapping/methods , Epicardial Mapping/trends , Humans , Kidney/innervation , Kidney/physiology , Review Literature as Topic , Tachycardia, Ventricular/diagnostic imaging , Treatment OutcomeABSTRACT
The purpose of this review is to update the reader on the relevance of autonomic nervous system imbalance in clinical cardiology. Increased sympathetic tone associates with the metabolic syndrome, hypertension and cardiac arrhythmias. With the kidneys playing a pivotal role in increased peripheral resistance, sodium and water retention and other mechanisms, renal denervation (RD) may theoretically restore autonomic imbalance and improve cardiovascular outcomes. Landmark RD trials and novel uses for RD in cardiac arrhythmia management are discussed.
