Soejima Kyoko, Yada Hirotaka
Arrhythmia Service, Department of Cardiology, University of Miami Hospital, Miami, Florida, USA.
J Cardiovasc Electrophysiol. 2009 May;20(5):578-83. doi: 10.1111/j.1540-8167.2008.01417.x. Epub 2009 Jan 9.
In patients with newly diagnosed AV block and/or ventricular tachycardia, cardiac sarcoidosis should always be considered in the differential diagnosis. In addition to the pacemaker implant, cardiac resynchronization therapy (CRT) should be selected for severe heart failure patients who have class III or IV heart failure, LVEF <or=35%, and a complete LBBB pattern. If the disease activity is high, corticosteroid therapy is recommended. Patients with extracardiac sarcoidosis need to be closely followed for potential cardiac involvement, as the mortality in sarcoidosis depends on cardiac involvement. Early diagnosis and treatment of cardiac sarcoidosis is essential. Positron emission tomography (PET) and cardiac magnetic resonance imaging (MRI) are considered to have high sensitivity for cardiac involvement, and are the preferred imaging modalities. However, even in the era of new technology, such as PET and cardiac MRI, early diagnosis of cardiac sarcoidosis is still difficult.
在新诊断为房室传导阻滞和/或室性心动过速的患者中，鉴别诊断时应始终考虑心脏结节病。除植入起搏器外，对于纽约心功能分级为III或IV级、左心室射血分数（LVEF）≤35%且完全性左束支传导阻滞图形的严重心力衰竭患者，应选择心脏再同步治疗（CRT）。如果疾病活动度高，建议使用皮质类固醇治疗。心脏外结节病患者需要密切随访有无潜在的心脏受累情况，因为结节病的死亡率取决于心脏受累情况。心脏结节病的早期诊断和治疗至关重要。正电子发射断层扫描（PET）和心脏磁共振成像（MRI）被认为对心脏受累具有高敏感性，是首选的成像方式。然而，即使在PET和心脏MRI等新技术时代，心脏结节病的早期诊断仍然困难。
