Section of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Heart Rhythm. 2012 Jun;9(6):884-91. doi: 10.1016/j.hrthm.2012.02.010. Epub 2012 Feb 13.
Ventricular tachyarrhythmias are an important cause of morbidity and mortality in cardiac sarcoidosis. To date, the prevalence and incidence of ventricular tachycardia/ventricular fibrillation (VT/VF) in this population remain unknown.
To determine the prevalence and incidence of ventricular tachyarrhythmias in patients with cardiac sarcoidosis and to identify the clinical attributes associated with appropriate implantable cardioverter-defibrillator (ICD) therapies.
We studied 45 patients with ICDs, biopsy-proven systemic sarcoidosis, and cardiac involvement, as evidenced by histopathology, cardiac magnetic resonance imaging, and/or (18)F-fluoro-2-deoxyglucose-positron emission tomography imaging. Device logs and medical records were retrospectively reviewed.
Appropriate ICD therapies for VT/VF were observed in 37.8% of the patients with an incidence of 15% per year. Inappropriate ICD therapies occurred in 13.3% of the patients. Longer ICD follow-up (4.5 ± 3.1 years vs 1.5 ± 1.5 years; P = .001), depressed left ventricular ejection fraction (35.5% ± 15.5% vs 50.9% ± 15.5%; P = .002), and complete heart block (47.1% vs 17.9%; P = .048) were associated with appropriate ICD therapy. While there was no significant difference in the total number of shocks/antitachycardia pacing-terminated events between primary (n = 29) and secondary (n = 16) prevention groups, there was a trend toward more events in the secondary prevention arm after 2 years.
Ventricular tachyarrhythmias requiring ICD therapy were common in patients with cardiac sarcoidosis, with an estimated incidence rate of 15% per year. Longer follow-up, left ventricular systolic dysfunction, and complete heart block were associated with VT/VF. Patients with primary prevention ICDs had high rates of appropriate ICD therapy but not as high as did secondary prevention patients. In the absence of reliable risk stratification techniques, consideration should be given to prophylactic ICD implantation in patients with cardiac sarcoidosis.
室性心动过速是心脏结节病患者发病率和死亡率的一个重要原因。迄今为止，该人群中心律失常（VT/VF）的患病率和发生率尚不清楚。
确定心脏结节病患者室性心动过速/心室颤动（VT/VF）的患病率和发生率，并确定与适当植入式心脏复律除颤器（ICD）治疗相关的临床特征。
我们研究了 45 名患有 ICD 的患者，这些患者经活检证实患有系统性结节病，且心脏受累，这通过组织病理学、心脏磁共振成像和/或（18）F-氟-2-脱氧葡萄糖正电子发射断层扫描成像得到证实。回顾性审查设备记录和病历。
VT/VF 的适当 ICD 治疗在 37.8%的患者中观察到，每年的发生率为 15%。在 13.3%的患者中发生了不适当的 ICD 治疗。ICD 随访时间更长（4.5±3.1 年比 1.5±1.5 年；P=.001）、左心室射血分数降低（35.5%±15.5%比 50.9%±15.5%；P=.002）和完全性心脏阻滞（47.1%比 17.9%；P=.048）与适当的 ICD 治疗相关。虽然在原发性（n=29）和继发性（n=16）预防组之间总电击/抗心动过速起搏终止事件的数量没有显著差异，但在继发性预防组中，2 年后事件发生的趋势更高。
心脏结节病患者需要 ICD 治疗的室性心律失常很常见，估计每年的发生率为 15%。较长的随访时间、左心室收缩功能障碍和完全性心脏阻滞与 VT/VF 相关。原发性 ICD 治疗的患者 ICD 治疗的适当率很高，但不如继发性预防患者高。在缺乏可靠的风险分层技术的情况下，应考虑对心脏结节病患者进行预防性 ICD 植入。
