Nery Pablo B, Beanlands Rob S, Nair Girish M, Green Martin, Yang Jim, McArdle Brian A, Davis Darryl, Ohira Hiroshi, Gollob Michael H, Leung Eugene, Healey Jeff S, Birnie David H
Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.
Division of Nuclear Medicine, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Canada.
J Cardiovasc Electrophysiol. 2014 Aug;25(8):875-881. doi: 10.1111/jce.12401. Epub 2014 May 2.
Atrioventricular block (AVB) can be caused by several conditions, including cardiac sarcoidosis (CS). The prevalence of CS causing this presentation in a North American population has not been investigated and was the purpose of this study.
We prospectively evaluated patients aged 18-60 years presenting with unexplained 2nd or 3rd degree AVB and no previous history of sarcoidosis in any organ. All patients had fluorodeoxyglucose-positron emission tomography (FDG-PET) scans for the evaluation of CS. Japanese Ministry of Health Welfare (JMHW) criteria and biopsy results were used to confirm the diagnosis of CS. Subjects with advanced imaging suggestive of CS were investigated for extracardiac involvement. Patients were followed for major adverse cardiac events.
Thirty-two patients presenting with unexplained AVB underwent cardiac and whole body FDG-PET for the investigation of CS from February 2010 to June 2013. Mean age was 52.8 ± 6.2 years, and 20 were male. CS was diagnosed in 11/32 (34%) subjects and 11/11 were subsequently diagnosed with extra-CS. Average follow-up was 21 ± 9 months. Adverse events were observed in 3 subjects with CS but none in subjects with idiopathic AVB. All 3 patients presented with heart failure, 2 also had recurrent VT resulting in ICD shocks.
In this prospective study of consecutive patients aged ≤60 years presenting with unexplained AVB, we found that 11/32 (34%) had previously undiagnosed CS. Among patients with CS, 3/11 had adverse clinical outcomes compared with 0/21 (P = 0.011). Our data suggest that all patients aged ≤60 years with unexplained AVB should be investigated for CS. Moreover, patients diagnosed with CS should be closely followed.
房室传导阻滞（AVB）可由多种情况引起，包括心脏结节病（CS）。北美人群中由CS导致这种表现的患病率尚未得到研究，而这正是本研究的目的。
我们对年龄在18 - 60岁、出现不明原因的二度或三度AVB且既往无任何器官结节病病史的患者进行了前瞻性评估。所有患者均接受氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）以评估CS。采用日本厚生省（JMHW）标准和活检结果来确诊CS。对影像学检查高度提示CS的患者进行心脏外受累情况的调查。对患者进行主要不良心脏事件的随访。
2010年2月至2013年6月，32例出现不明原因AVB的患者接受了心脏及全身FDG-PET检查以排查CS。平均年龄为52.8±6.2岁，其中20例为男性。11/32（34%）的受试者被诊断为CS，其中11/11随后被诊断为心脏外CS。平均随访时间为21±9个月。3例CS患者出现了不良事件，而特发性AVB患者未出现不良事件。所有3例患者均出现心力衰竭，2例还反复发生室性心动过速（VT），需植入式心律转复除颤器（ICD）电击治疗。
在这项对年龄≤60岁、出现不明原因AVB的连续患者的前瞻性研究中，我们发现11/32（34%）的患者此前未被诊断出CS。在CS患者中，3/11出现了不良临床结局，而特发性AVB患者中这一比例为0/21（P = 0.011）。我们的数据表明，所有年龄≤60岁、出现不明原因AVB的患者均应排查CS。此外，被诊断为CS的患者应密切随访。
