Abstract 15185: Risk Factors for Sudden Death in Chagas Cardiomyopathy

Abstract

Introduction: Sudden death (SD) is an important cause of death in Chagas Cardiomyopathy patients. We aim to identify associated factors for its occurrence in Chagas Cardiomyopathy patients requiring pacemaker (PM). Methods: We prospectively evaluated 527patients included in the PACINCHAGAS Study - Risk Stratification in Pacemaker Patients with Chagas Cardiomyopathy, which primary objective is to create a risk score to predict death in this population.The patients are submitted to an extent questionnaire which included clinical (NYHA class, symptoms, comorbidities and medications) functional (electrocardiography, holter and echocardiography) and electronic variables (burden of pacing and arrhythmias).Patients withat least 6 months of follow-up were included in this analysis. Results: The cohort included 337 (63.9%) females, the mean age was 62.6±12.0 years and 64.3% were in NYHA class I. Indication for PM implantation was atrioventricular block, sick sinus syndrome, atrial fibrillation with slow ventricular response and unknown in 72.7%; 20.7%; 4.7% and 1.9%, respectively. The mean time of PM was 11.6±9.0years. During a mean follow-up of 1.8±0.6 years, 74 (14.0%) patients died; 25 deaths (33.8%) were due to heart failure, 23 (31.0%)weresudden (9.7%), 8(10.9%) were due to other cardiovascular causes, and 11 (14.8%) were due to non-cardiovascular causes. The cause of death could not be determined in seven patients (9.5%).Univariate analysis shows that patients with SD were younger (57.1 versus 62.8years, P=0.033), have higher duration of QRS (172.8 versus 155.8msec, P=0.013), lower ejection fraction (38.7% versus 48.7%, P=0.002), higher left ventricular diastolic diameter (60.0 versus 48.7mm, P=0.001), higher systolic arterial pulmonary pressure (41.8 versus 34.9mmHg, P=0.038) and higher rate of segmental wall-motion abnormality (57.9% versus 23.3%, P=0.002. Advanced functional class and non-sustained ventricular tachycardia were not associated to SD. Conclusions: We found that lower age, higher QRS duration and presence of echocardiographic abnormalities were associated to sudden death in PM users with Chagas Cardiomyopathy.