Possibility of steroid therapy without pacemaker implantation in patients with sarcoidosis presenting atrioventricular block
Possibility of steroid therapy without pacemaker implantation in patients with sarcoidosis presenting atrioventricular block
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DOI：
10.1007/s00380-022-02092-1
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发表时间：
2022-05-14
影响因子：
1.5
通讯作者：
Shimizu, Wataru
中科院分区：
文献类型：
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作者：
Yodogawa, Kenji;Fujimoto, Yuhi;Shimizu, Wataru
房室传导阻滞（AVB）是心脏结节病（CS）的常见表现之一。虽然通常建议在CS合并症状性AVB的患者中植入起搏器，但一些病例报告显示，可以通过类固醇治疗而无需植入起搏器。本研究的目的是评估在CS合并症状性AVB患者中不植入起搏器的类固醇治疗的可行性和有效性。我们对2015年4月至2021年3月期间因症状性二度或三度AVB入住日本医科大学医院的连续10例CS患者进行了病历审查。在研究人群中，3例二度AVB患者在植入起搏器前接受类固醇治疗是可行的。其中2例术后房室传导恢复至1：1，经激素治疗后无起搏器。其余1名患者的房室传导没有改善，需要植入起搏器。7例三度AVB患者在类固醇治疗前需要植入器械（起搏器; n = 7，心脏起搏治疗除颤器; n = 1），主要是因为血流动力学不稳定。不植入起搏器的类固醇治疗可能是可行的，并且可能对出现二度AVB的CS患者有效。然而，在三度AVB患者中的可行性有限。
Atrioventricular Block (AVB) is one of the common manifestations in cardiac sarcoidosis (CS). Although pacemaker implantation is generally recommended in patients with CS complicated by symptomatic AVB, some case reports have shown that they can be managed by steroid therapy without pacemaker implantation. The aim of this study was to evaluate the feasibility and effectiveness of steroid therapy without pacemaker implantation in patients with CS complicated by symptomatic AVB. We performed medical record review of consecutive ten CS patients who admitted Nippon Medical School Hospital for symptomatic second or third degree AVB between April 2015 and March 2021. Of the studied population, steroid therapy before pacemaker implantation was feasible in three patients with second degree AVB. Two of them showed subsequent recovery of atrioventricular conduction to 1:1, and they were managed by steroid therapy without pacemaker. The remaining one patient showed no improvement of atrioventricular conduction and required pacemaker implantation. Seven patients with third degree AVB required device implantation (pacemaker; n = 7, cardiac resynchronization therapy defibrillator; n = 1) before steroid therapy mainly because of hemodynamic instability. Steroid therapy without pacemaker implantation might be feasible, and possibly be effective in patients with CS presenting second degree AVB. However, the feasibility is limited in patients with third degree AVB.