New perspectives on catheter-based ablation of ventricular tachycardia complicating Chagas' disease: experimental evidence of the efficacy of near infrared lasers for catheter ablation of Chagas' VT.
Chronic Chagas' myocarditis can alter the myocardial substrate in a way that facilitates the emergence of fatal VT in a way similar to the long-term consequences of myocardial infarction. Post-myocardial infarction and Chagas' VT share many similarities: they are both macroreentrant circuits, entrainable, involving any wall segment from the endocardium to the epicardium. However, as compared to patients with post-MI VT, Chagasic patients tend to be younger and have a higher left ventricular ejection fraction. It is assumed, therefore, that their prognosis is closely related to VT treatment rather than the progression of the myocardial damage caused by the disease itself. Although sudden death is a rare event in patients in NYHA functional class I and II treated with amiodarone, VT recurrence rate is 30% a year. Drug therapy is ineffective for patients with advanced heart failure (100% recurrence rate/40% mortality in 1 year). Open-chest surgery is effective but requires very specialized centers and great expertise making its widespread use unrealistic. The results of combining RF endo/epicardial catheter ablation are still disappointing. Thus, research protocols on the search for new ablation technologies may greatly impact overall mortality in this subset of patients. This review will focus on the limitations of the current catheter-based ablation technology and suggest that an alternative approach is urgently needed. Experimental evidence of the efficacy of near infrared Lasers for catheter ablation will be reported along with investigations of the optical properties of the chagasic myocardium in the near infrared region to indicate that it might be not only feasible but also an appropriate choice to treat these patients.
d'Avila
André
A
Unit of Cardiac Arrhythmia of the Heart Institute (InCor) of the University of São Paulo Medical School, Brazil.
Splinter
Robert
R
Svenson
Robert H
RH
Scanavacca
Mauricio
M
Pruitt
Ernest
E
Kasell
Jackie
J
Sosa
Eduardo
E
D000818:Animals; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D002598:Chagas Cardiomyopathy / Q000150:complications*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D004195:Disease Models, Animal; D004285:Dogs; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007259:Infrared Rays / Q000627:therapeutic use*; D017075:Laser Coagulation / Q000295:instrumentation / Q000379:methods*; D053685:Laser Therapy / Q000295:instrumentation / Q000379:methods*; D009203:Myocardial Infarction / Q000150:complications; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000401:mortality / Q000469:parasitology* / Q000601:surgery*