The Chagas storm - an uncommon presentation of the disease: A case report and literature review

Objective: We present as case of rare manifestation of electrical storms due to Chagas cardiomyopathy, the complexity of its management, and how to resolve them. Case presentation: Female patient with no cardiovascular history, was admitted to the hospital with palpitations, dyspnea, diaphoresis and atypical oppressive chest pain. In the emergency department, she was diagnosed with ventricular tachycardia (VT) with hemodynamic stability, doctors decided to start pharmacological cardioversion with intravenpusly without clinical improvement or achieving cardioversion, and then after detecting an evolution in hemodynamic instability, electrical cardioversion was performed at 200 J with return to sinus rhythm. However, she experienced multiple recurrences of VT, so due to suspicion of ischemic etiology, she underwent diagnostic coronary angiography where epicardial arteries were reported without significant lesions and imaging suggestive of inferior basal aneurysm. Transthoracic echocardiogram revealed left ventricle dilated, left ventricular ejection fraction of 49% and possible Chagas-related cardiomyopathy due to an aneurysm was suspected and serology for Chagas was requested with a “reactive” result, confirming the diagnosis. The patient is currently under treatment with class III antiarrhythmic and beta-blocker with adequate adherence and follow-up without any electrical instability so far. Conclusion: In hemodynamically unstable patients with Chagas disease and electrical storm, intravenous antiarrhythmics are the initial choice. Ablation is effective in controlling recurrent VT (electric storm) as a definitive therapy. Combined endocardial/epicardial catheter ablation strategies reduce VT/ventricular fibrillation recurrences but do not cure the disease.