Division of Cardiology, Geriatrics, and Integrated Medicine, Department of Internal Medicine, Nippon Medical School, Tokyo 113-8603, Japan.
J Cardiol. 2013 Nov;62(5):320-5. doi: 10.1016/j.jjcc.2013.07.007. Epub 2013 Sep 6.
Atrioventricular (AV) block is one of the main clinical manifestations in patients with cardiac sarcoidosis (CS). Although steroid therapy is considered to be effective for AV block, the efficacy has not been demonstrated in detail.
Fifteen CS patients presenting with advanced or complete AV block were retrospectively investigated. All patients were treated with 30mg/day of prednisone after device implantation, which was tapered to a maintenance dosage of 5-10mg/day. During a mean follow-up of 7.1 years, AV block resolved to normal conduction or first-degree AV block in 7 patients (recovery group). The improvement was driven within the first week of steroid therapy in 4 patients, while 3 patients showed late recovery of AV conduction. The remaining 8 patients were classified as the non-recovery group. The recovery group showed a higher left ventricular ejection fraction (69.4±8.9% versus 44.1±19.3%, p=0.029) and higher prevalence of advanced AV block (87.5% versus 28.6%, p=0.040) compared with those of the non-recovery group. In patients with the recovery group, there was no late recurrence of AV block during the follow-up period.
Early initiation of steroid therapy may be effective for AV block, and steroid therapy before device implantation is a possible therapeutic strategy for some selected patients.
房室（AV）传导阻滞是心脏结节病（CS）患者的主要临床表现之一。尽管皮质类固醇治疗被认为对 AV 传导阻滞有效，但尚未详细证明其疗效。
回顾性调查了 15 例出现晚期或完全性 AV 传导阻滞的 CS 患者。所有患者在植入器械后均接受 30mg/天的泼尼松治疗，然后逐渐减量至 5-10mg/天的维持剂量。平均随访 7.1 年后，7 例患者（恢复组）的 AV 传导阻滞恢复为正常传导或一度 AV 传导阻滞。4 例患者在皮质类固醇治疗的第一周内出现改善，3 例患者出现 AV 传导的迟发性恢复。其余 8 例患者被归类为未恢复组。与未恢复组相比，恢复组的左心室射血分数更高（69.4±8.9%比 44.1±19.3%，p=0.029），且更易出现晚期 AV 传导阻滞（87.5%比 28.6%，p=0.040）。在恢复组的患者中，在随访期间没有出现迟发性 AV 阻滞复发。
早期开始皮质类固醇治疗可能对 AV 传导阻滞有效，在植入器械之前进行皮质类固醇治疗可能是某些选定患者的一种治疗策略。
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