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Outcome of Cardiac Sarcoidosis Presenting With High-Grade Atrioventricular Block.
- Source :
-
Circulation. Arrhythmia and electrophysiology [Circ Arrhythm Electrophysiol] 2018 Aug; Vol. 11 (8), pp. e006145. - Publication Year :
- 2018
-
Abstract
- 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.<br />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.<br />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).<br />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.
- Subjects :
- Adolescent
Adult
Aged
Atrioventricular Block mortality
Atrioventricular Block physiopathology
Atrioventricular Block therapy
Cardiac Pacing, Artificial
Cardiomyopathies mortality
Cardiomyopathies physiopathology
Clinical Decision-Making
Death, Sudden, Cardiac epidemiology
Death, Sudden, Cardiac prevention & control
Defibrillators, Implantable
Electric Countershock instrumentation
Female
Finland epidemiology
Heart Rate
Humans
Incidence
Male
Middle Aged
Prognosis
Registries
Risk Assessment
Risk Factors
Sarcoidosis mortality
Sarcoidosis physiopathology
Severity of Illness Index
Stroke Volume
Tachycardia, Ventricular mortality
Tachycardia, Ventricular physiopathology
Tachycardia, Ventricular therapy
Time Factors
Ventricular Dysfunction, Left mortality
Ventricular Dysfunction, Left physiopathology
Ventricular Dysfunction, Left therapy
Ventricular Function, Left
Young Adult
Atrioventricular Block epidemiology
Cardiomyopathies epidemiology
Sarcoidosis epidemiology
Tachycardia, Ventricular epidemiology
Ventricular Dysfunction, Left epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1941-3084
- Volume :
- 11
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Circulation. Arrhythmia and electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 30354309
- Full Text :
- https://doi.org/10.1161/CIRCEP.117.006145