How is cardiopathy treated in Chagas disease (American trypanosomiasis)?

Updated: Apr 26, 2019
  • Author: Louis V Kirchhoff, MD, MPH; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Atrial and ventricular rhythm disturbances may require pacemaker placement. Ablation procedures for tachyarrhythmias, as well as implanted defibrillators, have been used in some patients with Chagas disease.

The usefulness of implantable cardioverter devices in patients with advanced Chagas heart disease is controversial. [108, 161, 162, 163, 164]

The usefulness of resection of the left ventricular apical aneurysms that develop in some patients with Chagas cardiomyopathy has not been established.

Cardiac transplantation is an option for some patients with end-stage Chagas heart disease, and hundreds of patients have undergone this procedure in Argentina, Brazil, and the United States. [165, 166, 167] Interestingly, the survival rate among patients with Chagas disease who have undergone cardiac transplantation is better than that in the general group of patients who have undergone cardiac transplantation for other reasons, [168] probably because the pathogenic process that results in cardiomyopathy in Chagas disease is not systemic, as is the case in diabetes mellitus, for example. Reactivation of the underlying T cruzi infection was a severe problem when the first such transplantations were performed in the late 1980s in Brazil; however, this is less of a problem now with the reduced dosing of immunosuppressives. [169, 170, 171]


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