Medical treatment of cardiac arrhythmias in Chagas'heart disease
Keywords:
Chronic chagasic cardiomyopathy, Cardiac arrhythmia, Antiarrhythmic drugsAbstract
There are no controlled clinical trials evaluating drug therapy in patients with ventricular arrhythmias and chronic chagasic cardiomyopathy. Empirical treatment with disopyramide (400-1,000mg/d), phenytoin (4-6mg/d), mexiletine (600-1,200mg/d), propafenone (900mg/d), amiodarone ( loading: 1,000mg/d, 10-14 days; maintenance 200-600mg/d), and sotalol (320mg/d) had efficacy and tolerance ranging from 18% to 90% with heterogeneous criteria for efficacy definition. Further studies with homogenous criteria are required to determine which is the most appropriate drug therapy for patients with chronic chagasic cardiomyopathy and ventricular arrhythmias.
Downloads
References
ALBANESI FILHO, F.M.; DA ROCHA. P.J.; BENCHIMOL, C.B.; GINEFRA, P. & BENCHIMOL, A.B. - Disopiramida no tratamento da extra-sistolia ventricular da cardiopatia chagásica crônica. Arq Bras Cardiol 33: 453-8, 1979.
CAPS investigators - The cardiac arrhytmia pilot study, Am J Cardiol 57: 91-5, 1986.
CARRASCO, H.A.; VICUNA, A.V.; MOLINA, C. et al. - Effect of low oral doses of disopyramide and amiodarone on ventricular and atrial arrhytmias of chagasic patients with advanced myocardial damage. Int J Cardiol 9: 425-38, 1985.
CHIALE, P.; HALPERN, S.; NAU, G.J. et al. - Efficacy of amiodarone during long-term treatment of malignant ventricular arrhytmias in patients with chronic chagasic myocarditis. Am Heart J 107: 656-65, 1984.
DA SILVA, M.A.D.; FRAGATA FILHO, A.A.; BOAINAIN, E. & MAGALHÃES, H.M. - Avaliação da propafenoma em pacientes chagásicos com extra-sistolia ventricular. Arq Bras Cardiol 36: 437-40, 1981.
DE PAOLA, A.A.V.; HOROWITZ, L.; SPIELMAN, S.R. et al. - Development of congestive heart failure and alterations in left ventricular function in patients with sustained ventricular tachyarrhythmias treated with amiodarone. Am J Cardiol 60: 276-80, 1987.
DE PAOLA, A.A.V.; HOROWITZ, L.N.; MIYAMOTO, M.H. et al. - Angiographic and electrophysiologic substrates of ventricular tachycardia in chronic chagasic myocarditis. Am J Cardiol 65: 360-3, 1990.
DE PAOLA, A.A.V.; HOROWITZ, L.N.; MIYAMOTO, M.H. et al. - Angiographic and electrophysiologic substrates of ventricular tachycardia in chronic chagasic myocarditis. Am Heart J 118: 415-7, 1989.
DE PAOLA, A.V.V.; HOROWITZ, L.N.; MORGANROTH, J. et al. - Influence of left ventricular dysfunction on flecainide theraphy. J Am Coll Cardiol 9: 163-8, 1987.
DE PAOLA, A.A.V.; GOMES, J.A.; SOUZA, I.A.; PINHEIRO, R.; GUIGUER JR, N. & MARTINEZ FILHO, E.E. - Localization of the site of the origin of sustained ventricular tachycardia in chronic chagasic cardiomyopathy. PACE 16: 871, 1993.
DE PAOLA, A.A.V.; GOMES, J.A.; SOUZA, I.A.; VATTIMO, A.C.; GUIGUER JR, N. & MARTINEZ FILHO, E.E. - Efficacy of amiodarone in patients with ventricular tachycardia and chronic chagasic cardiomyopathy. J Am Coll Cardiol 23 (Suppl): 322A, 1994.
GONDIN, F.A.A.; DE PAOLA, A.A.V.; SILVA, R.M.F.L.; METHA, N. & MARTINEZ FILHO, E.E. - Eficácia e tolerância do sotatol em pacientes com taquiarritmias ventriculares sustentadas. Arq Bras Cardiol 62: 64, 1994.
GRECO, O.T.; LORGA, A.M.; GARZON, S.A.C. et al. - A amiodarona nas arritmias ventriculares da cardiopatia chagásica crônica. Arq Bras Cardiol 35: 177-81, 1980.
JURADO, A.Z. & DE FEUILADE, N.D. - Empleo del mexiletine en las arritmias ventriculares de la cardiopatia chagasica. Prensa Med Argent 73: 665-73, 1986.
LORGA, A.M.; GRECO, O.T.; GARZON, S.A.C. et al. - Mexitil no tratamento de arritmias ventriculares de cardiopatas chagásicos crônicos. Rev Bras Med (Cardiologia) 2: 47-52, 1983.
MASON, J.W. - For the ESVEM investigators. A comparison of seven antiarrhythmie drugs in patients with ventricular tachyarrhythmias. N Engl J Med 329: 452-8, 1993.
NETTO, O.S.; DE PAOLA, A.A.V.; MENDONÇA, A. et al. - Fatores relacionados com a ocorrência de taquicardia ventricular ou óbito em pacientes portadores de cardiopatia chagásica crônica. Arq Bras Cardiol 61: 19, 1993.
PINHEIRO, R.; DE PAOLA, A.A.V.; MIYAMOTO, M.H. et al. - Morte súbita em pacientes com cardiopatia chagásica crônica e taquicardia ventricular não sustentada. Arq Bras Cardiol 57: 134, 1991.
PODRID, P.J.; SCHOENENBERGER, A. & LOWN, B. - Congestive heart failure caused by oral disopyramide. N Engl J Med 302: 614-7, 1980.
PORTO, C.C.; GUIMARÃES, E.; ROSA, J. & RASSI, A. - Propafenoma na prevenção das extra-sístoles ventriculares de etiologia chagásica relacionadas com o esforço físico. Avaliação por circloergometria. Arq Bras Cardiol 39: 129-33, 1982.
PRATA, A.P.; BATISTA, E.P. & PENHALVER, J.R. - Uso de amiodarona em arritmias cardíacas de chagásicos crônicos. F Med(BR) 85: 713-7, 1982.
RASSI, A. & PERINI, G. - Ensaio cego com disopiramida no tratamento de extra-sistolia ventricular da cardiopatia chagásica crônica controlado através do sistema Holter de eletrocardiografia dinâmica. Arq Bras Cardiol 41: 72, 1983.
ROSENBAUM, M.; POSSE, R.; SGAMMINI, H. et al. - Estudio clinico multicentrico comparativo de la flecainida y la amiodarona en el tratamiento de las arritmias ventriculares asociadas a la cardiopatia chagasica cronica. Arch Inst Cardiol Mex 57: 325-30, 1987.
SCANAVACCA, M.I.; SOSA, E.A.; LEE, J.H.; BELLOTTI, G. & PILEGGI, F. - Terapêutica empírica com amiodarona em portadores de miocardiopatia chagásica crônica e taquicardia ventricular sustentada. Arq Bras Cardiol 54: 367-71, 1990.
SGAMMINI, H.O.; EVEQUOZ, M.C.; CHUIT, R.; ATTI, R.; SANTAMARINA, N.O. & KUSCHNIR, E. - Tratamiento de las arritmias de alto riesgo de muerte subita en la cardiopatia chagasica cronica con mexiletine oral. Evaluacion con monitoreo electrocardiografico ambulatorio de 24 h (Holter). Arq Bras Cardiol 40: 103-9, 1983.
SOSA, E.; BARBERO, M.; SCALABRINI, A.; BELLOTTI, G.; JATENE, A. & PILEGGI, F. - Surgical treatment of recurrent ventricular tachycardia in chronic chagasic heart disease. (Abstractr book) Washington: X World Congress of Cardiology 1986. 117 p.
SUAREZ-KURTZ, G.; LORGA, A.M. & MORAES, F.D. - Effects of phenytoin on the ventricular tachyarrhythmias of chronic Chagas'disease. Int J Cardiol 36: 81-6, 1992.
The Cardiac Arrhytmia Suppression Trial (CAST) Investigators - Effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Eng J Med 321: 406-12, 1989.
YUSUF, S.; VENKATECH, G. & TEO, K.K. - Critical review of the approaches to the prevention of sudden death. Am J Cardiol 72: 51-8, 1993.
