Abstract 4348798: Comparative Study of Electrophysiologic Pacing Parameters in Patients with Chagas Disease from Honduras

Abstract

Background: Chagas disease, caused by the parasite Trypanosoma cruzi, is a public health concern in Latin America and an emerging health issue in the United States, leading to significant cardiac complications, including heart failure and arrhythmias. Aim: This study aimed to investigate the electrophysiologic characteristics of patients with Chagas disease to identify differences in cardiac conduction and electrical activity among these patients. Methods: We included a total of 242 patients from a single center in Honduras with indications for pacemaker implantation from September 2010 to September 2024. Pacemaker parameter data (P wave amplitude, P wave thresholds, R wave amplitude, R wave thresholds and Atrial and Ventricular lead impedance) were collected at the time of implantation and follow up. Data was analyzed using T-test (mean [95% Confidence Interval]) and multivariable regression models controlling for age, sex and Ejection Fraction (EF). Results: There were 82 patients with serologic positive Chagas disease and 160 without Chagas disease. Mean (±SD) age was not different between two groups (65.15± 11.43 vs.65.72±16.88, NS). Left ventricular EF (LVEF) ≤55% was the only variable that was more prevalent in the Chagas group [36(47%) vs. 33(21%), p<0.001]. The frequency of hypertension, diabetes, and hyperlipidemia were not statistically different between the two groups (data not shown). Among pacemaker parameters at the time of device implantation, patients with Chagas compared to non-Chagas group showed significantly lower P wave amplitude (1.69 mV [1.32-2.05] vs 2.40 mV [2.06-2.87], p=0.009). Meanwhile, at the time of device follow up the Chagas group showed significantly lower P wave amplitude (1.05 mV [0.69-1.42] vs. 2.53 mV [2.12-2.94], p=0.012) and R wave amplitude (5.34 mV [3.92-6.76] vs. 7.87 mV [6.84-8.90], p=0.049). Multivariable regression analysis controlling for age, sex and LVEF ≤55 confirmed these results (data not shown). There was no difference between groups for the rest of the parameters studied. Conclusion: Our study shows that Chagas cardiomyopathy significantly affects atrial and ventricular signal conduction. Further research into the physiological pathways behind these abnormalities is needed to improve treatment guidelines, which are often limited by the overlap of heart failure and arrhythmias. A deeper understanding of Chagas disease could support the development of new targeted therapies for this often-overlooked disease.