Electro‐Mechanical Dissociation in Chagas Cardiomyopathy: Comparative Analysis of Arrhythmic Burden Beyond <scp>LVEF</scp>

ABSTRACT Background Chronic Chagas cardiomyopathy (CCC) exhibits high arrhythmic risk despite preserved systolic function, challenging LVEF‐based stratification. Methods We performed a cross‐sectional analysis of 146 heart failure patients (75 CCC, 71 Ischemic Cardiomyopathy [IC]) with comparable age, LVEF, and NT‐proBNP. Results CCC patients had a higher arrhythmic burden and NSVT prevalence (RR 4.37, 95% CI 1.67–11.39). NSVT prevalence in CCC was similar regardless of LVEF ( p = 0.707). Conventional heart failure severity markers, including worse global and regional strain, were associated with NSVT in IC but not in CCC, where atrial fibrillation ( p = 0.002) and ventricular aneurysms ( p = 0.033) were the primary associated variables. Conclusions Arrhythmic vulnerability in CCC appears decoupled from LVEF, suggesting that complementary substrate‐based markers may improve risk stratification in this population.