Borislav Dinov, Carsten Henfling, Hans Ebbinghaus, Konrad Latuscynski, Ingo Paetsch, Cosima Jahnke, Samuel Sossalla, Ulrich Laufs, Laura Ueberham
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Excluding those with VA, 82 patients remained and were divided into 2 groups: 34 individuals with AVB as initial presentation and 48 with other symptoms as first presentation (OSF). Both groups were compared for clinical characteristics, rates of VA, LVAD implantation, heart transplantation and mortality.</p><p><strong>Results: </strong>During follow-up, VA was detected in 50% in the AVB and 10.4% in the OSF group; P = 0.001. Death, LVAD implantation, heart transplantation occurred in 11.8% in AVB vs. 10.4% in the OSF; P = 0.847. Late gadolinium enhancement (LGE) was equally observed in both groups: 70% vs. 70.5%; P = 0.966, whereas more patients in the AVB group exhibited abnormal PET uptake: 86.2% vs. 54.3%; P = 0.007. In multivariate analysis, AVB (HR 25.15), RV LGE in CMR (HR 7.39) were predictors for VA occurrence, whereas the use of immunosuppressive therapy was associated with less VA (HR 4.3).</p><p><strong>Conclusions: </strong>Patients with CS presenting with AVB have a high risk of sustained VA. 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引用次数: 0
摘要
背景:房室传导阻滞(AVB)是心脏肉瘤病(CS)的常见首发症状,但也可能发生危险的室性心律失常(VA)。尽管数据稀少,但指南仍建议在需要时植入 ICD 而不是起搏器:在这项研究中,我们旨在确定因房室传导阻滞而出现起搏指征的 CS 患者持续 VA 的预测因素:我们前瞻性地招募了 112 名 CS 患者。方法:我们前瞻性地招募了 112 名 CS 患者,剔除有 VA 的患者后,剩下 82 名患者被分为两组:34 名以房室传导阻滞为首发症状,48 名以其他症状为首发症状(OSF)。两组患者的临床特征、VA发生率、LVAD植入率、心脏移植率和死亡率进行了比较:结果:在随访期间,50%的AVB组和10.4%的OSF组发现了VA;P = 0.001。AVB 组有 11.8%的患者死亡、植入 LVAD 或接受心脏移植;OSF 组有 10.4%的患者死亡、植入 LVAD 或接受心脏移植;P = 0.847。两组患者均观察到晚期钆增强(LGE):70% vs. 70.5%;P = 0.966,而 AVB 组患者 PET 摄取异常的比例更高:86.2% vs. 54.3%;P = 0.007。在多变量分析中,AVB(HR 25.15)和CMR中的RV LGE(HR 7.39)是VA发生的预测因素,而使用免疫抑制剂治疗与较少的VA有关(HR 4.3):结论:伴有 AVB 的 CS 患者发生持续 VA 的风险很高。尽管免疫抑制剂可减少 VA 的发生,但植入 ICD 是合理的,尤其是在右心室 LGE 的情况下。
Rates and predictors for sustained ventricular tachycardia in patients with cardiac sarcoidosis and AV block as first cardiac presentation: implications for device implantation.
Background: Atrioventricular block (AVB) is a frequent initial presentation of cardiac sarcoidosis (CS), but dangerous ventricular arrhythmias (VA) can occur. Despite the scarcity of data, guidelines recommend ICD rather than a pacemaker implantation whenever a device is needed.
Objective: In this study, we aimed to establish predictors for sustained VA in patients with CS presenting with pacing indication due to an AVB.
Methods: We prospectively enrolled 112 patients with CS. Excluding those with VA, 82 patients remained and were divided into 2 groups: 34 individuals with AVB as initial presentation and 48 with other symptoms as first presentation (OSF). Both groups were compared for clinical characteristics, rates of VA, LVAD implantation, heart transplantation and mortality.
Results: During follow-up, VA was detected in 50% in the AVB and 10.4% in the OSF group; P = 0.001. Death, LVAD implantation, heart transplantation occurred in 11.8% in AVB vs. 10.4% in the OSF; P = 0.847. Late gadolinium enhancement (LGE) was equally observed in both groups: 70% vs. 70.5%; P = 0.966, whereas more patients in the AVB group exhibited abnormal PET uptake: 86.2% vs. 54.3%; P = 0.007. In multivariate analysis, AVB (HR 25.15), RV LGE in CMR (HR 7.39) were predictors for VA occurrence, whereas the use of immunosuppressive therapy was associated with less VA (HR 4.3).
Conclusions: Patients with CS presenting with AVB have a high risk of sustained VA. Although immunosuppressive drugs may reduce the occurrence of VA, ICD implantation is reasonable, especially in case of right ventricular LGE.
期刊介绍:
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.