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Outcome of Cardiac Sarcoidosis Presenting With High-Grade Atrioventricular Block




TekijätNordenswan Hanna-Kaisa, Lehtonen Jukka, Ekström Kaj, Kandolin Riina, Simonen Piia, Mäyränpää Mikko, TVihinen Tapani, Miettinen Heikki, Kaikkonen Kari, Haataja Petri, Kerola Tuomas, Rissanen Tuomas T, Kokkonen Jorma, Alatalo Aleksi, Pietilä-Effati Päivi, Utriainen Seppo, Kupari Markku

KustantajaWolters Kluwer

KustannuspaikkaAmsterdam

Julkaisuvuosi2018

JournalCirculation: Arrhythmia and Electrophysiology

Tietokannassa oleva lehden nimiCIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY

Lehden akronyymiCirc Arrhythm Electrophysiol .

Artikkelin numeroe006145

Vuosikerta11

Numero8

Sivujen määrä9

ISSN1941-3149

eISSN1941-3084

DOIhttps://doi.org/10.1161/CIRCEP.117.006145

Verkko-osoitehttps://www-ahajournals-org.ezproxy.utu.fi/doi/full/10.1161/CIRCEP.117.006145?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org


Tiivistelmä

Background: Symptomatic high-grade atrioventricular block (AVB) is the most common and often the only presenting manifestation (lone AVB) of cardiac sarcoidosis. Implantation of an intracardiac cardioverter defibrillator instead of a pacemaker is recommended, but the true risk of fatal arrhythmia, one incident to lone AVB in particular, remains poorly known.

Methods: We used Myocardial Inflammatory Diseases in Finland Study Group Registry to analyze the presentations, left ventricular (LV) function, pacemaker therapy, and ventricular arrhythmias in cardiac sarcoidosis. From year 1988 to 2015, altogether 325 cases of cardiac sarcoidosis were diagnosed in Finland. Of them, 143 patients (112 women, mean age 52 years) presented with Mobitz II second degree or third degree AVB in the absence of other explanatory cardiac disease.

Results: Concomitant with AVB at presentation, 20 patients had either ventricular tachycardia or severe LV dysfunction with ejection fraction <35% and 29 patients had nonsevere LV dysfunction (ejection fraction, 35%-50%) while 90 patients presented with AVB alone. During a median of 2.8 years' follow-up, 23 sudden cardiac deaths (fatal or aborted) and 19 ventricular tachycardias were recorded as arrhythmic end point events. Their composite 5-year incidence (95% confidence interval) was 56% (36%-88%) in the AVB subgroup with ventricular tachycardia or severe LV dysfunction versus 24% (12%-49%) in the subgroup with nonsevere LV dysfunction and 24% (15%-38%) with lone AVB ( P=0.019). The 5-year incidence of sudden cardiac death was 34% (16%-71%), 14% (6%-35%), and 9% (4%-22%) in the respective subgroups ( P=0.060).

Conclusions: The risk of sudden cardiac death is significant in cardiac sarcoidosis presenting with high-grade AVB with or without ventricular tachycardia or LV dysfunction. The consensus recommendation to implant an intracardiac cardioverter defibrillator whenever permanent pacing is needed seems well-founded.



Last updated on 2024-26-11 at 18:26