Electrocardiogram and Chagas Disease A Large Population Database of Primary Care Patients

Background: Chagas disease (ChD) used to be a disease restricted to Latin America, but has become a worldwide problem due to migration of infected individuals to developed countries. Electrocardiography has been considered an essential exam to evaluate ChD patients. Objective: This study sought to identify prevalent electrocardiographic abnormalities in a large sample of ChD patients evaluated in the primary care setting. Methods: This retrospective observational study assessed all consecutive digital 12-lead electrocardiograms ( ECG) performed by the Telehealth Network of Minas Gerais, Brazil, from January 1 to December 31, 2011. In that time, the service attended primary care patients in 660 cities in the Minas Gerais province. ChD was self-reported, and the individuals who did not report having ChD were considered noninfected. The prevalence of electrocardiographic abnormalities was assessed. Results: Self-reported ChD patients comprised 7,590 (2.9%) of 264,324 patients who underwent ECG during the study period. The mean age for ChD patients was 57.0 +/- 13.7 years, and 64.1% of patients were women. The most common comorbidities were hypertension (61.3%), diabetes (9.1%), and dyslipidemia (6.9%), and 10.7% were smokers. The most frequent electrocardiographic abnormalities were nonspecific repolarization abnormalities (34.6%), right bundle branch block (RBBB) (22.7%), left anterior hemiblock (LAH) (22.5%), ventricular premature beats (5.4%), and atrial fibrillation (5.4%). Only 31.5% of the patients had no electrocardiographic abnormality versus 61.2% in noninfected individuals (p < 0.001). The prevalence of normal ECG decreased with aging and was significantly lower than for noninfected individuals in all age groups. Pacemaker rhythm (odds ratio [OR]: 13.3, 95% confidence intervals [CI]: 11.5 to 15.4), RBBB (OR: 10.7, 95% CI: 10.1 to 11.4), especially in association with LAH (OR: 12.1, 95% CI: 11.2 to 13.0), second atrioventricular block (OR: 4.1, 95% CI: 2.5 to 6.6), and third atrioventricular block (OR: 13.3, 95% CI: 11.5 to 15.4) were strongly related to ChD. Conclusions: In this large sample of primary care patients with ChD, there was a high prevalence of electrocardiographic abnormalities. Pacemaker rhythm, RBBB, especially in association with LAH, and second and third atrioventricular block were strongly related to ChD.