PREVALENCE OF CHAGAS DISEASE IN HIGH RISK PATIENTS WITH PACEMAKER IN A US BASED CLINIC

Background: Chagas disease (CD) is a common parasitic disease in Latin America, where an estimated 8 million persons are infected, and leads to severe chronic complications. CD is present even in non-endemic countries due to migration, with an estimated prevalence of 300,000 in the US. Approximately 30-40% of those with CD will develop cardiac manifestations including conduction abnormalities, heart failure, and sudden death. These conduction abnormalities often lead to pacemaker placement. The objective of this study is to assess the prevalence of Chagas disease in Latin-American immigrants who have a pacemaker implanted in a Los Angeles County hospital.

Methods: A cross-sectional prospective study was implemented at the Center of Excellence for Chagas Disease (CECD) at Olive View-UCLA Medical Center to detect the prevalence of CD in Latin-American immigrants with an implanted pacemaker. Patients at least 18 years old who lived in Latin America for at least 6 months at any point in their lives with a pacemaker were invited to take part of this study. Patients with a concomitant defibrillator or cardiomyopathy were excluded. Blood samples were screened serologically to establish CD diagnosis using an enzyme immunoassay, and a Trypomastigote excreted-secreted antigen Western blot performed at the Centers for Disease Control (CDC) laboratories.

Results: There were a total of 385 patients with pacemakers in the clinic. A total of 115 patients met inclusion criteria and informed consent was obtained from 81 patients; the rest declined participation or were lost to follow-up. The enrollment period was from March 2014 to March 2015. Out of 81 patients, six were seropositive for Trypanosoma Cruzi, resulting in a seropositive prevalence of 7.5%. From the six positive patients, 4/12 were from El Salvador (33%), 1/49 from Mexico (2%) and 1/1 from Argentina (100%). The average age of positive patients was 78 years versus 68 years for negative patients.

Conclusion: Our study demonstrates that the prevalence of CD among patients with conduction disease requiring pacemakers is high among Latin American immigrants. Screening for CD should be considered for all patients with unexplained cardiac conduction disease from endemic regions.