Incidence of Ventricular Arrhythmias after Stem Cell
               Therapy in Patients with Chagas Cardiomyopathy

Souza, Adriana Sebba Barroso de; Souza, Weimar Kunz Sebba Barroso; Costa, Sandra Araujo; Freitas, Elis Marra de Moreira; Carvalho, Gustavo; Sá, Luís Antônio Batista; Rassi, Salvador

doi:10.5935/abc.20140053

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Original Articles • Arq. Bras. Cardiol. 102 (05) • 10 June 2014 • https://doi.org/10.5935/abc.20140053 copy

Incidence of Ventricular Arrhythmias after Stem Cell Therapy in Patients with Chagas Cardiomyopathy

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background:

Treatment with stem cells in several cardiomyopathies may be related to the increase in arrhythmias.

Objectives:

To determine whether intracoronary injection of stem cells in patients with Chagas cardiomyopathy is associated with increased incidence of ventricular arrhythmias, compared to the Control Group.

Methods:

A retrospective cohort study that evaluated the medical records of 60 patients who participated in a previous cross-sectional study. The following data were collected: age, gender, drugs used and Holter variables that demonstrated the presence of arrhythmias. Holter was performed in four stages: randomization, 2, 6 and 12 months segments. The Control Group received medical treatment and intracoronary injection of placebo and the Study Group had drug treatment and autologous stem cell implant.

Results:

There was no difference between Control Group and Study Group when analyzing the arrhythmia criteria. In the intra-group analysis, significant difference was found between the Holter tests of the Study Group for the variable total ventricular premature beats when compared with baseline, with p = 0.014 between Holter at randomization and Holter at 2 months, p = 0.004 between Holter at randomization and Holter at 6 months, and p = 0.014 between Holter at randomization and Holter at 12 months. The variable non-sustained ventricular tachycardia between Holter at randomization and Holter at 6 months showed p = 0.036.

Conclusion:

The intracoronary injection of stem cells did not increase the incidence of ventricular arrhythmias in patients with Chagas cardiomyopathy compared to the Control Group.

Arrhythmias; Cardiac; Stem Cell Transplantation; Chagas Cardiomyopathy

Variable	Study Group	Control Group	p value
Holter 1	(n = 34)	(n = 26)
Total number of beats	81,209.33 ± 17,417.57	86,343.54 ± 17,474.21	0.189
Total ventricular premature beats	2,685.18 ± 3,052.48	2,640.06 ± 3,412.12	0.435
Total supraventricular premature beats	926.77 ± 3,659.93	2.330.33 ± 9,875.09	0.514
NSVT	5.15 ± 12.02	3.79 ± 5.68	0.744
Total SVT episodes	0.00 ± 0.0	0.0 ± 0.0	-
Holter 2	(n = 32)	(n = 26)
Total number of beats	89,474.62 ± 10,906.01	88,457.09 ± 20,175.04	0.994
Total ventricular premature beats	3,764.00 ± 5,313.65	3,611.22 ± 4,549.22	0.478
Total supraventricular premature beats	1.363.07 ± 4,609.85	457.41 ± 1,703.04	0.994
NSVT	29.92 ± 135.33	14.77 ± 33.31	0.456
Total SVT episodes	0.0 ± 0.0	0.0 ± 0.0	-
Holter 3	(n = 28)	(n = 21)
Total number of beats	92,394.25 ± 11,519.21	94,715.06 ± 19,856.30	0.836
Total ventricular premature beats	4,817.48 ± 6,152.71	5,072.41 ± 7,508.33	0.379
Total supraventricular premature beats	1,893.07 ± 5,341.60	2,580.45 ± 9,623.00	0.809
NSVT	30.11 ± 135.37	24.12 ± 56.53	0.956
Total SVT episodes	2.11 ± 10.96	0.0 ± 0.0	0.277
Holter 4	(n = 26)	(n = 16)
Total number of beats	96,965.00 ± 10,386.72	91,487.25 ± 16,403.77	0.255
Total ventricular premature beats	9,713.17 ± 1,8607.40	4,234.29 ± 4,010.05	0.459
Total supraventricular premature beats	1,480.58 ± 2,957.37	2,477.79 ± 8,422.73	0.862
NSVT	19.17 ± 36.47	2.25 ± 4.59	0.117
Total SVT episodes	0.12 ± 0.61	0.0 ± 0.0	0.400

Variable	*Total number of beats^ * Student test was used;**	Total number of ventricular premature beats^ in total heartbeats and Wilcoxon test; p < 0.05.	Salvos of NSVT^ in total heartbeats and Wilcoxon test; p < 0.05.	Total episodes of SVT^ in total heartbeats and Wilcoxon test; p < 0.05.
Holter 1 vs. Holter 2	0.524	0.014^* ***** in total ventricular extrasystoles NSVT and SVT episodes and was found significance p < 0,05 for both items. Holter 1: performed at randomization; Holter 2: performed at 2 months of follow-up; Holter 3: performed at 6 months of follow-up; Holter 4: performed at 12 months of follow-up. NSVT: nonsustained ventricular tachycardia; SVT: sustained ventricular tachycardia.	0.070	1.000
Holter 1 vs. Holter 3	0.024^* ***** in total ventricular extrasystoles NSVT and SVT episodes and was found significance p < 0,05 for both items. Holter 1: performed at randomization; Holter 2: performed at 2 months of follow-up; Holter 3: performed at 6 months of follow-up; Holter 4: performed at 12 months of follow-up. NSVT: nonsustained ventricular tachycardia; SVT: sustained ventricular tachycardia.	0.004^* ***** in total ventricular extrasystoles NSVT and SVT episodes and was found significance p < 0,05 for both items. Holter 1: performed at randomization; Holter 2: performed at 2 months of follow-up; Holter 3: performed at 6 months of follow-up; Holter 4: performed at 12 months of follow-up. NSVT: nonsustained ventricular tachycardia; SVT: sustained ventricular tachycardia.	0.036^* ***** in total ventricular extrasystoles NSVT and SVT episodes and was found significance p < 0,05 for both items. Holter 1: performed at randomization; Holter 2: performed at 2 months of follow-up; Holter 3: performed at 6 months of follow-up; Holter 4: performed at 12 months of follow-up. NSVT: nonsustained ventricular tachycardia; SVT: sustained ventricular tachycardia.	0.317
Holter 1 vs. Holter 4	0.083	0.014^* ***** in total ventricular extrasystoles NSVT and SVT episodes and was found significance p < 0,05 for both items. Holter 1: performed at randomization; Holter 2: performed at 2 months of follow-up; Holter 3: performed at 6 months of follow-up; Holter 4: performed at 12 months of follow-up. NSVT: nonsustained ventricular tachycardia; SVT: sustained ventricular tachycardia.	0.375	0.102

Variable	*Total number of beats^ * Student test was used;**	Total number of ventricular premature beats^ in total heartbeats and Wilcoxon test; p < 0.05.	Salvos of NSVT^ in total heartbeats and Wilcoxon test; p < 0.05.	Total episodes of SVT^ in total heartbeats and Wilcoxon test; p < 0.05.
Holter 1 vs. Holter 2	0.026^* ***** in total ventricular extrasystoles NSVT and SVT episodes and was found significance p < 0,05 for both items. Holter 1: performed at randomization; Holter 2: performed at 2 months of follow-up; Holter 3: performed at 6 months of follow-up; Holter 4: performed at 12 months of follow-up. NSVT: nonsustained ventricular tachycardia; SVT: sustained ventricular tachycardia.	0.239	0.984	1.000
Holter 1 vs. Holter 3	0.014^* ***** in total ventricular extrasystoles NSVT and SVT episodes and was found significance p < 0,05 for both items. Holter 1: performed at randomization; Holter 2: performed at 2 months of follow-up; Holter 3: performed at 6 months of follow-up; Holter 4: performed at 12 months of follow-up. NSVT: nonsustained ventricular tachycardia; SVT: sustained ventricular tachycardia.	0.161	0.975	0.317
Holter 1 vs. Holter 4	0.015^* ***** in total ventricular extrasystoles NSVT and SVT episodes and was found significance p < 0,05 for both items. Holter 1: performed at randomization; Holter 2: performed at 2 months of follow-up; Holter 3: performed at 6 months of follow-up; Holter 4: performed at 12 months of follow-up. NSVT: nonsustained ventricular tachycardia; SVT: sustained ventricular tachycardia.	0.128	0.061	1.000

Comparison	Control group		Study group
Comparison	Salvos of NSVT (p)	Total episodes of SVT (p)	Salvos of NSVT (p)	Total episodes of SVT (p)
Holter 1 vs. Holter 2	0.904	1.000	0.286	1.000
Holter 1 vs. Holter 3	0.796	0.317	0.198	1.000
Holter 1 vs. Holter 4	0.753	1.000	0.381	0.317

Variable	Study Group (n = 34) n (%)	Control Group (n = 26) n (%)	p value
ARB	7 (25.9)	10 (30.3)	0.212
Digitalis	14 (51.9)	14 (42.4)	0.158
ACEI	8 (29.6)	10 (30.3)	0.222
Spironolactone	19 (70.4)	21 (63.6)	0.188
Diuretics	19 (70.4)	25 (75.8)	0.206
Amiodarone	10 (37.0)	11 (33.3)	0.204
Beta-blockers	2 (7.4)	12 (36.4)	0.171

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