Relationship between arrhythmogenesis and disease activity in cardiac sarcoidosis

Banba, Kimikazu; Kusano, Kengo; Nakamura, Kazufumi; Morita, Hiroshi; Ogawa, Aiko; Ohtsuka, F; Ogo, Keiko; Nishii, Nobuhiro; Watanabe, Atsuyuki; Nagase, Satoshi; Sakuragi, Satoru; Ohe, Tohru

doi:10.1016/j.hrthm.2007.06.006

Cited by 157 publications

(121 citation statements)

References 21 publications

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“…Small‐sized retrospective studies showed that steroid improved nearly 50% of cardiac sarcoidosis patients with complete AV block 2, 3. Chapelon‐Abric et al demonstrated that clinical response to prednisolone was limited to the early stage of cardiac sarcoidosis 6.…”

Section: Discussionmentioning

confidence: 99%

“…It is presumed that the substrate for arrhythmias includes inflammation and following fibrosis because of sarcoidosis as well as acute fulminant myocarditis. Complete AV block because of cardiac sarcoidosis recovered to normal sinus rhythm after corticosteroid therapy in 57% 2, 3. On the other hand, a systemic review demonstrated that corticosteroids might have little benefit on VT from cardiac sarcoidosis 4…”

Section: Introductionmentioning

confidence: 99%

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Steroid pulse therapy was effective for cardiac sarcoidosis with ventricular tachycardia and systolic dysfunction

et al. 2016

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A 32‐year‐old man presented with palpitation. He was diagnosed with pulmonary sarcoidosis by lung biopsy. The electrocardiogram showed first‐degree atrioventricular block and complete right bundle branch block (CRBBB). We planned to examine laboratory data, echocardiography, Holter monitoring, and gallium‐67 scintigraphy. Before he went through all these exams, he developed ventricular tachycardia. After defibrillation was performed, his electrocardiogram revealed complete atrioventricular block. We observed elevation of serum angiotensin‐converting enzyme levels. In addition, both of gallium‐67 scintigraphy and 18F‐fluorodeoxyglucose positron emission tomography showed abnormal uptake in the ventricular septum. We diagnosed the patient with cardiac sarcoidosis associated with these arrhythmias. We started treatment with methylprednisolone pulse therapy (1 g daily). After 3 days of steroid pulse therapy, we administered prednisolone 30 mg daily. On day 15, electrocardiogram changed from complete atrioventricular block to first‐degree atrioventricular block and CRBBB. He was discharged with no progression with cardiac sarcoidosis for 2 years.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Steroid pulse therapy was effective for cardiac sarcoidosis with ventricular tachycardia and systolic dysfunction

et al. 2016

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“…Although preliminary in nature, the results show that patients with episodes of sustained VT had significantly higher FDG uptake when compared with Studies reporting correlations between abnormalities on imaging and clinical presentation in CS patients, particularly using FDG PET, are extremely limited, and quantitative analysis of SUV values has not previously been used for this purpose. Banba et al 17 performed Gallium scanning in 15 CS patients presenting with either AVB or VT. Interestingly, abnormal Gallium uptake was documented in 80% of AVB patients, but only 14% of the VT cohort. Similar to our results EF was lower and there was a high prevalence of perfusion abnormalities in the VT cohort.…”

Section: Discussionmentioning

confidence: 99%

Is There an Association Between Clinical Presentation and the Location and Extent of Myocardial Involvement of Cardiac Sarcoidosis as Assessed by ¹⁸ F- Fluorodoexyglucose Positron Emission Tomography?

Ardle

Birnie

Klein

et al. 2013

Circ: Cardiovascular Imaging

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“…3 In our series, 56% (18/32) of the total group and 69% (18/26) of the biopsy-diagnosed patients had an ICD implanted. It may be that arrhythmias respond poorly to immunosuppression in GCM because, as in cardiac sarcoidosis, 12 they are related to myocardial scars rather than to active inflammation.…”

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confidence: 99%

Diagnosis, Treatment, and Outcome of Giant-Cell Myocarditis in the Era of Combined Immunosuppression

Kandolin

Lehtonen

Salmenkivi

et al. 2013

Circ: Heart Failure

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G iant-cell myocarditis (GCM) is known as a rare, rapidly progressive, and frequently fatal myocardial disease in young and middle-aged adults. It is attributed to a T lymphocyte-mediated inflammation of the heart muscle and associates with systemic autoimmune diseases in ≈20% of cases. 1,2The most common early manifestations are heart failure, ventricular arrhythmias, and atrioventricular block, but GCM may also disguise as an acute myocardial infarction and rarely presents as an unexpected sudden cardiac death.1-3 The diagnosis of GCM rests fully on microscopy of the heart muscle and even in experienced centers >4 in 10 cases may escape detection until autopsy or cardiac transplantation. Aside from nonspecific measures to combat its symptomatic manifestations, the treatment of GCM relies on immunosuppression. Retrospective observations from the Multicenter GCM Registry 1,4 and a small prospective study with repeat biopsies 5 suggest that cyclosporine-based combined immunosuppression may be able to reduce myocardial inflammation 5 and improve clinical outcome. 1,4,5 Yet, these data are uncontrolled and suffer from lack of details about the treatments given 1,4 and the possibility of survivor bias. 1,4,5 The key problem is that the rarity and seriousness of GCM make controlled treatment trials, let alone use of a placebo arm, virtually impossible. The only such attempt, a cooperative endeavor by 17 centers, was terminated after 6 years because of difficulties in recruiting patients.5 Therefore, carefully studied observational patient series continue to add to the knowledge about GCM. We report here our experience in 32 patients with GCM, of whom 26 received combined immunosuppression. We focus on the diagnosis of GCM and on the outcome of patients with contemporary treatment. Our key observations suggest that repeat and imaging-guided biopsies increase the detection rate of GCM and that combined immunosuppression supported by therapy for heart failure and arrhythmias may result in transplant-free survival in two thirds of patients. Clinical Perspective on p 22 Methods PatientsFrom the year 1991 through 2011, 32 patients with histologically verified GCM were seen at the Division of Cardiology, Helsinki University Central Hospital. The majority of diagnoses (29/32) were made after year 2000, that is, during the latter half of the study period. The medical records, laboratory test, imaging studies, and available biopsy material of all patients were retrospectively reviewed and © 2012 American Heart Association, Inc. Background-Giant-cell myocarditis often escapes diagnosis until autopsy or transplantation and has defied proper treatment trials for its rarity and deadly behavior. Current therapy rests on multiple-drug immunosuppression but its prognostic influence remains poorly known. We set out to analyze (1) our experience in diagnosing giant-cell myocarditis and (2) the outcome of patients on combined immunosuppression. Methods and Results-We reviewed the histories, diagnostic procedures, details of treatment, a...

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Relationship between arrhythmogenesis and disease activity in cardiac sarcoidosis

Cited by 157 publications

References 21 publications

Steroid pulse therapy was effective for cardiac sarcoidosis with ventricular tachycardia and systolic dysfunction

Steroid pulse therapy was effective for cardiac sarcoidosis with ventricular tachycardia and systolic dysfunction

Is There an Association Between Clinical Presentation and the Location and Extent of Myocardial Involvement of Cardiac Sarcoidosis as Assessed by ¹⁸ F- Fluorodoexyglucose Positron Emission Tomography?

Diagnosis, Treatment, and Outcome of Giant-Cell Myocarditis in the Era of Combined Immunosuppression

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Relationship between arrhythmogenesis and disease activity in cardiac sarcoidosis

Cited by 157 publications

References 21 publications

Steroid pulse therapy was effective for cardiac sarcoidosis with ventricular tachycardia and systolic dysfunction

Steroid pulse therapy was effective for cardiac sarcoidosis with ventricular tachycardia and systolic dysfunction

Is There an Association Between Clinical Presentation and the Location and Extent of Myocardial Involvement of Cardiac Sarcoidosis as Assessed by 18 F- Fluorodoexyglucose Positron Emission Tomography?

Diagnosis, Treatment, and Outcome of Giant-Cell Myocarditis in the Era of Combined Immunosuppression

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Is There an Association Between Clinical Presentation and the Location and Extent of Myocardial Involvement of Cardiac Sarcoidosis as Assessed by ¹⁸ F- Fluorodoexyglucose Positron Emission Tomography?