Sarcoidosis

Recovery of Transient High-Grade Atrioventricular Block Managed With Corticosteroid Therapy Without Device Implantation in Newly Diagnosed Cardiac Sarcoidosis: A Case Report

“…Specifically, early treatment, younger age, and preserved LV systolic function are reported to have higher rates of AVB recovery for which our patient met all characteristics. However, our patient had some features that have been associated with increased mortality and worse outcomes: the presence of a high-grade AVB, LGE noted on CMR, and elevated troponins on admission [10]. Notably, the presence of LGE on CMR in the setting of normal LV function for our patient would be a class IIa recommendation according to HRS guidelines for an electrophysiology study (EPS) to assess candidacy for device therapy as recovery of AVB may not be expected [8].…”

“…Although various society guidelines recommend device implantation for patients with CS complicated by AVB, there exists an ongoing debate regarding the necessity of device therapy in this specific patient population [10,12]. A recently published retrospective study, for instance, evaluated the efficacy of steroid therapy alone in the treatment of AVB in CS without seeking PPM or ICD implantation [9].…”

“…Finally, there have been a few cases reported whereby clinicians have administered high-dose steroid therapy, also known as pulse steroid therapy, for cases of complete AVB that lead to recovery as well and again without pursuing device therapy [15,16]. Thus, as previous cases and clinicians have discussed, there may be a cohort of CS patients with high-grade AVB that can optimally be managed with steroid therapy alone without needing urgent device implantation [10,12].…”

“…However, since the inception of the 2014 HRS guidelines, there has been growing discussion that there may be potential overtreatment with device therapy in patients with CS complicated by symptomatic AVB [6]. Specifically, some authors have argued that early initiation of corticosteroid therapy without device implantation may be a potential therapeutic approach for carefully selected patients with symptomatic AVB [9,10]. We present a case of newly diagnosed CS with concomitant transient type II Mobitz AVB in a patient that was successfully managed with corticosteroid therapy without ICD implantation and without any concerning cardiovascular events in the ensuing year.…”