Applicability of the AHA/ACC/HRS Guideline for Implantable Cardioverter Defibrillator Implantation in Japanese Patients With Cardiac Sarcoidosis

Takenaka, Sakae; Kobayashi, Yuta; Nagai, Toshiyuki; Kato, Yoshiya; Komoriyama, Hirokazu; Nagano, Nobutaka; Kamiya, Kiwamu; Konishi, Takao; Sato, Takuma; Omote, Kazunori; Mizuguchi, Yoshifumi; Tada, Atsushi; Sato, Tomoya; Iwano, Hiroyuki; Kusano, Kengo; Ishibashi‐Ueda, Hatsue; Anzai, Toshihisa

doi:10.1016/j.jacep.2021.04.009

Cited by 4 publications

(5 citation statements)

References 23 publications

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“…Of note, equal findings were recently found in a Japanese study applying the 2017 ACC/AHA/HRS recommendations to a cohort of 188 consecutive patients with CS. 35 Even then, nearly all patients (95%) had Class I or IIa ICD indications, and the rest had serious events (SCD, ventricular fibrillation, or ventricular tachycardia) at a rate close to the annualized rate of 2.1% in patients with Class IIa indications. 35 We believe that these observations reflect the high arrhythmogenicity of CS rather than just suggesting that the guidelines are poorly formulated.…”

Section: Discussionmentioning

confidence: 94%

“… 35 Even then, nearly all patients (95%) had Class I or IIa ICD indications, and the rest had serious events (SCD, ventricular fibrillation, or ventricular tachycardia) at a rate close to the annualized rate of 2.1% in patients with Class IIa indications. 35 We believe that these observations reflect the high arrhythmogenicity of CS rather than just suggesting that the guidelines are poorly formulated. Still, their risk assessment tools need improvement.…”

Section: Discussionmentioning

confidence: 94%

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Incidence of Sudden Cardiac Death and Life-Threatening Arrhythmias in Clinically Manifest Cardiac Sarcoidosis With and Without Current Indications for an Implantable Cardioverter Defibrillator

et al. 2022

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Background: Cardiac sarcoidosis (CS) predisposes to sudden cardiac death (SCD). Guidelines for implantable cardioverter defibrillators (ICDs) in CS have been issued by the Heart Rhythm Society in 2014 and the American College of Cardiology/American Heart Association/Heart Rhythm Society consortium in 2017. How well they discriminate high from low risk remains unknown. Methods: We analyzed the data of 398 patients with CS detected in Finland from 1988 through 2017. All had clinical cardiac manifestations. Histological diagnosis was myocardial in 193 patients (definite CS) and extracardiac in 205 (probable CS). Patients with and without Class I or IIa ICD indications at presentation were identified, and subsequent occurrences of SCD (fatal or aborted) and sustained ventricular tachycardia were recorded, as were ICD indications emerging first on follow-up. Results: Over a median of 4.8 years, 41 patients (10.3%) had fatal (n=8) or aborted (n=33) SCD, and 98 (24.6%) experienced SCD or sustained ventricular tachycardia as the first event. By the Heart Rhythm Society guideline, Class I or IIa ICD indications were present in 339 patients (85%) and absent in 59 (15%), of whom 264 (78%) and 30 (51%), respectively, received an ICD. Cumulative 5-year incidence of SCD was 10.7% (95% CI, 7.4%–15.4%) in patients with ICD indications versus 4.8% (95% CI, 1.2%–19.1%) in those without (χ 2 =1.834, P =0.176). The corresponding rates of SCD were 13.8% (95% CI, 9.1%–21.0%) versus 6.3% (95% CI, 0.7%–54.0%; χ 2 =0.814, P =0.367) in definite CS and 7.6% (95% CI, 3.8%–15.1%) versus 3.3% (95% CI, 0.5%–22.9%; χ 2 =0.680, P =0.410) in probable CS. In multivariable regression analysis, SCD was predicted by definite histological diagnosis ( P =0.033) but not by Class I or IIa ICD indications ( P =0.210). In patients without ICD indications at presentation, 5-year incidence of SCD, sustained ventricular tachycardia, and emerging Class I or IIa indications was 53% (95% CI, 40%–71%). By the American College of Cardiology/American Heart Association/Heart Rhythm Society guideline, all patients with complete data (n=245) had Class I or IIa indications for ICD implantation. Conclusions: Current ICD guidelines fail to distinguish a truly low-risk group of patients with clinically manifest CS, the 5-year risk of SCD approaching 5% despite absent ICD indications. Further research is needed on prognostic factors, including the role of diagnostic histology. Meanwhile, all patients with CS presenting with clinical cardiac manifestations should be considered for an ICD implantation.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

Incidence of Sudden Cardiac Death and Life-Threatening Arrhythmias in Clinically Manifest Cardiac Sarcoidosis With and Without Current Indications for an Implantable Cardioverter Defibrillator

et al. 2022

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“…61 These recommendations have been validated in American and Japanese cohorts, with consistent results. 62,63 The key difference between the 2 documents pertains to patients without significant LV dysfunction (i.e., LVEF >35%). The 2017 document suggested ICD implantation (Class IIa recommendation) in patients with evidence of extensive myocardial scar by CMR or PET scan.…”

Section: Diagnostic Criteriamentioning

confidence: 99%

Diagnosis and Treatment of Cardiac Sarcoidosis

Bortoli

Birnie

2023

Circ J

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About 5% of sarcoidosis patients develop clinically manifest cardiac features. Cardiac sarcoidosis (CS) typically presents with conduction abnormalities, ventricular arrhythmias and heart failure. Its diagnosis is challenging and requires a substantial degree of clinical suspicion as well as expertise in advanced cardiac imaging. Adverse events, particularly malignant arrhythmias and development of heart failure, are common among CS patients. A timely diagnosis is paramount to ameliorating outcomes for these patients. Despite weak evidence, immunosuppression (primarily with corticosteroids) is generally recommended in the presence of active inflammation in the myocardium. The burden of malignant arrhythmias remains important regardless of treatment, thus leading to the recommended use of an implantable cardioverter defibrillator in most patients with clinically manifest CS.

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“… 82 , 83 Another retrospective study of CS in Japan revealed that patients with Class 2a indication for ICD and inducible sustained ventricular arrhythmia had no SCD and ventricular arrhythmia events, which may indicate that electrophysiology is not useful for SCD risk stratification of CS. 84 Although the ACC/AHA guidelines (without the statement for NSVT and electrophysiology) is valid for Asian patients with CS, further study is needed for SCD risk stratification.…”

Section: Cardiac Sarcoidosismentioning

confidence: 99%

Use of Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death in Asia

et al. 2023

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Applicability of the AHA/ACC/HRS Guideline for Implantable Cardioverter Defibrillator Implantation in Japanese Patients With Cardiac Sarcoidosis

Cited by 4 publications

References 23 publications

Incidence of Sudden Cardiac Death and Life-Threatening Arrhythmias in Clinically Manifest Cardiac Sarcoidosis With and Without Current Indications for an Implantable Cardioverter Defibrillator

Incidence of Sudden Cardiac Death and Life-Threatening Arrhythmias in Clinically Manifest Cardiac Sarcoidosis With and Without Current Indications for an Implantable Cardioverter Defibrillator

Diagnosis and Treatment of Cardiac Sarcoidosis

Use of Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death in Asia

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