A Case of Sudden Cardiac Arrest Due to Chagas Disease: Management and Decision for Implantable Cardioverter-Defibrillator Placement

A 55-year-old male from El Salvador presented to an emergency department in the northeastern United States with diarrhea, vomiting, dizziness, and melena. Shortly after arrival, the patient's heart rate increased to 235 beats/min with a narrow QRS complex, which subsequently degenerated into a wide complex ventricular tachycardia (VT). Initial workup revealed severe transaminitis, reduced systolic function, and an anomalous right coronary artery. After extensive diagnostic workup, including cardiac magnetic resonance imaging and serologies, a diagnosis of Chagas cardiomyopathy was made. Given the presence of arrhythmogenic substrate and a high Rassi score for sudden cardiac death, the patient underwent placement of an implantable cardioverter-defibrillator (ICD) for secondary prevention of VT. This case underscores the increasing importance of considering Chagas disease in patients in the United States coming from endemic countries and the decision-making process regarding ICD placement in a patient with underlying Chagas-related cardiomyopathy.