BACKGROUND Electrophysiologic Study (EPS) is a diagnostic tool that can further evaluate patients prone to arrhythmic death.OBJECTIVE To shed light on the causes of death in Chagas disease, specially on regards of importance of the VT induction and chances of death, as evaluated by Rassi clinical score. METHODS We evaluated data from 153 patients with Chagas disease from the electrophysiology laboratory from a tertiary center between January of 2011 and January 2013. All patients were evaluated with 1, 2, 3 or 4 ventricular extra-stimuli followed by runs of 10 beats fast ventricular stimulation. If VT or VF is inducible the patients are referred to ICD implant or VT ablation. RESULTS Of a total of 153 patients, 48% were male, mean age 58 ±12 years (24 - 84 years). As for risk of death according to the clinical score, 32% were evaluated as low risk, 35,4% intermediate, 32,6% high risk. NSVT on 24 hour Holter (p=0,009), stimulation on EPS (p<0,001), lower VEFE (p<0,01), cardiomegaly (p<0,001) and high risk on Rassi score (p<0,001) where the more associated variables to ventricular tachyarrithmias. CONCLUSIONS Clinical score is an interesting tool to further stratify patients in higher risk for VT induction during EPS, which is also a marker of higher risk of sudden cardiac death. Some characteristics as Non sustained VT, Pulmonary congestion, cardiomegaly and low voltage QRS were the most relevant determinants for inducible VT on EPS. The duration of NSVT is also important for VT induction in EPS.

Introduction Ventricular arrhythmias (VAs) are a major cause of morbidity and mortality in patients with heart disease. Recent studies evaluated the effect of renal denervation (RDN) on the occurrence of VAs. We conducted a systematic review and meta-analysis to determine the efficacy and safety of this procedure. Methods and results A systematic search of the literature was performed to identify studies that evaluated the use of RDN for the management of VAs. Primary outcomes were reduction in the number of VAs and implantable cardioverter-defibrillator (ICD) therapies. Secondary outcomes were changes in blood pressure and renal function. Ten studies (152 patients) were included in the meta-analysis. RDN was associated with a reduction in the number of VAs, ATP (antitachycardia pacing), ICD shocks and overall ICD therapies of 3.53events/patient/month (95%CI=-5.48 to -1.57), 2.86events/patient/month (95%CI=-4.09 to -1.63), 2.04events/patient/month (95%CI=-2.12 to -1.97), and 2.68events/patient/month (95%CI=-3.58 to -1.78), respectively. Periprocedural adverse events occurred in 1.23% of patients and no significant changes were seen in blood pressure or renal function. Conclusions In patients with refractory VAs, RDN was associated with a reduction in the number of VAs and ICD therapies, and was shown to be a safe procedure. KEYWORDS: Renal denervation, ventricular arrhythmias, implantable cardioverter-defibrillator, antitachycardia pacing, ICD shocks.

INTRODUCTION: Malignant ventricular arrhythmias (MVA) are often the main cause of sudden cardiac death (SCD), especially in patients with pre-existing coronary artery disease (CAD). The identification of factors associated with SCD in this clinical setting is important and might help physicians in identifying this high risk group of patients. We evaluated the association between 12-lead ECG ventricular repolarization parameters and the induction of MVA on the electrophysiological study (EPS). METHODS AND RESULTS: 177 patients [mean age 65±10.1yo, 83.6% male, mean LV ejection fraction (LVEF) 37.5±13.6%] were analyzed. For each 10ms increment in the QT interval, an increase of 7% in MVA inducibility was observed. The QT cut-off point of 452 ms had and accuracy of 0.611 for predicting MVA (p=0.011). Male gender (OR=4.18, p=0.012), LVEF < 35% (OR=2.32, p=0.013), amiodarone use (OR=2.01, p=0.038) and prolonged QT (OR=1.07, p=0.023) were independent factors associated with MVA. QT > 452ms in patients with ventricular dysfunction was associated with significant increased risk of MVA (OR=5.44, p=0.0004). In patients with LVEF ≥ 35%, QT dispersion (QTd) was significantly higher in those with inducible MVA. QTd > 20ms had an accuracy of 0.638 in predicting MVA, with 81.3% negative predictive value (95% CI 63-92.1%). CONCLUSION: QT interval was an independent factor associated with MVA in patients with CAD. The combination of ventricular dysfunction and prolonged QT interval was associated with a 5-fold increase of MVA induction. Male gender, amiodarone use and decreased LVEF were also associated with increased risk of inducibility of MVA on the EPS.