IJCS | Volume 31, Nº2, March / April 2018

185 Patients with positive serologic test results Normal EGG Not normal NYHA classes III/IV NYHA classes I/II X-ray: normal cardiac area X-ray: Cardiomegaly ECG – normal LVEF ECG – Reduced LVEF Holter without NSVT Holter with NSVT Holter without NSVT Holter with NSVT Low risk Intermediate risk High risk Figure 6 – Algorithm for risk stratification in patients with Chagasic Chronic Cardiopathy. Adapted from Rassi et al. Circulation. 2007;115:1101-8 and reprinted from the I Latin American guideline for the diagnosis and treatment of Chagas cardiomyopathy.1 difficult todifferentiate fromorganrejection; however, results through the use of trypanosomicidal therapy were found. Treatment of cardiac arrhythmias Bradyarrhythmias and AV block Patients with second- or third-degree AVB or symptomatic sinus node dysfunction require definitive pacemaker implantation. In this respect, CCC does not seem to differ fromother etiologies, and usual guidelines for indicating these devices must be followed. Arritmias ventriculares e morte súbita arrítmica The optimal approach for the management of severe ventricular arrhythmias and resuscitated sudden cardiac death secondary to CCC is still uncertain due to absolute lack of data. The first therapeutic measure in patients with CCC under risk of malignant ventricular arrhythmia is the optimization of drug therapy for those who also have heart failure, preferably with the concomitant use of beta-blockers and amiodarone. The ICD implantation is useful in the secondary prevention of sudden cardiac death, in survivors of sudden arrhythmic death or with sustained ventricular tachycardia, especially when accompanied by hemodynamic instability. For those who are not candidates for the implantation of this device, the use of amiodarone is recommended. In fact, there is acceptable evidence of potential benefit for this antiarrhythmic drug in patients with ventricular arrhythmias of Chagas disease etiology. The concomitant use of amiodarone and beta-blockers is also recommended routinely to reduce the number of therapies, even when appropriate, due to ICD implantation in patients with CCC. A multicenter randomized trial (CHAGASICS) is underway to assess the ICD benefit versus amiodarone, for primary prevention of sudden death in patients with CCC and high Rassi score. 82 Amiodarone can be used, ideally associated with a beta-blocker, for patients with CCC, Rassi risk score of ≥10 points and nonsustained ventricular tachycardia detected on Holter monitoring. Simões et. al. Chagas Disease Cardiomyopathy Int J Cardiovasc Sci. 2018;31(2)173-189 Review Article