Department of Medicine, Division of Cardiology, Heart Rhythm Center, University of Chicago, Chicago, Illinois.
Department of Medicine, University of Illinois Medical Center, Chicago, Illinois.
Am J Cardiol. 2014 May 1;113(9):1556-60. doi: 10.1016/j.amjcard.2014.01.434. Epub 2014 Feb 12.
Cardiovascular magnetic resonance (CMR) imaging is being increasingly used to help identify patients with cardiac sarcoidosis (CS). Whereas ventricular arrhythmias have been well studied in this population, atrial arrhythmias have not been thoroughly investigated. We sought to better characterize the arrhythmia burden of a cohort of patients diagnosed with CS by CMR imaging. Patients with biopsy-proven extracardiac sarcoidosis were referred to the University of Chicago for evaluation of the presence of CS. CMR imaging was used to categorize the patients into 2 groups; those with and those without late gadolinium enhancement (LGE) for comparison of arrhythmic events. Arrhythmic evaluation included Holter monitor, event recorder, electrophysiology testing, or implantable cardioverter-defibrillator (ICD) interrogation; 192 consecutive patients were evaluated with CMR imaging, 57 of whom did not have ambulatory monitoring results and thus were excluded. LGE was present in 44 patients. Atrial arrhythmias were documented in 16 patients (36%) with myocardial LGE and in 11 patients (12%) without myocardial LGE (p = 0.002). Ventricular arrhythmias were documented in 27% of patients with myocardial LGE and 2.2% of LGE-negative patients (p = 0.00076). Of 26 LGE-positive patients with ICDs, 8 (30.8%) received therapies, 3 (11.5%) of which were inappropriate for atrial arrhythmias. In conclusion, atrial arrhythmias were documented more frequently than ventricular arrhythmias in patients with sarcoidosis with cardiac involvement and were 3 times more prevalent than in patients with sarcoidosis without cardiac involvement. Risk-benefit assessment of anticoagulation for primary prevention of stroke should be performed for patients with CS. In patients receiving implantable defibrillators, programming to minimize inappropriate ICD shocks for atrial arrhythmias must be considered.
心血管磁共振（CMR）成像越来越多地用于帮助识别患有心脏结节病（CS）的患者。虽然在该人群中已经对室性心律失常进行了充分研究，但尚未对房性心律失常进行彻底研究。我们试图通过 CMR 成像更好地描述一组经 CMR 成像诊断为 CS 的患者的心律失常负担。活检证实为心脏外结节病的患者被转介到芝加哥大学评估 CS 的存在。CMR 成像用于将患者分为 2 组；那些有和那些没有晚期钆增强（LGE）以比较心律失常事件。心律失常评估包括动态心电图监测、事件记录器、电生理测试或植入式心脏复律除颤器（ICD）询问；192 例连续患者进行 CMR 成像评估，其中 57 例无动态监测结果，因此被排除在外。LGE 存在于 44 例患者中。有心肌 LGE 的 16 例患者（36%）和无心肌 LGE 的 11 例患者（12%）记录到房性心律失常（p = 0.002）。有心肌 LGE 的患者中记录到 27%的室性心律失常，而 LGE 阴性患者中记录到 2.2%的室性心律失常（p = 0.00076）。26 例 LGE 阳性且装有 ICD 的患者中，有 8 例（30.8%）接受了治疗，其中 3 例（11.5%）为治疗房性心律失常的不适当治疗。总之，在有心脏受累的结节病患者中，房性心律失常比室性心律失常更常见，比无心脏受累的结节病患者更常见 3 倍。对于 CS 患者，应进行抗凝治疗以预防中风的风险效益评估。在接受植入式除颤器的患者中，必须考虑编程以尽量减少心房颤动的不适当 ICD 电击。
