Yalagudri Sachin, Zin Thu Ngwe, Devidutta Soumen, Saggu Daljeet, Thachil Ajit, Chennapragada Sridevi, Narasimhan Calambur
Department of Cardiac Arrhythmia and Electrophysiology Services, CARE Hospital, Hyderabad, India.
J Cardiovasc Electrophysiol. 2017 Aug;28(8):893-902. doi: 10.1111/jce.13228.
Treating ventricular tachycardia (VT) in patients with cardiac sarcoidosis (CS) is challenging as patients present in different phase of the disease (inflammatory, scar, or sometimes both). A customized approach to treatment is required for better outcomes. We describe our experience in the management of VT in CS based on the phase of the disease.
Patients were considered to have myocardial inflammation if there was an increased myocardial fluorodeoxy glucose (FDG) uptake in PET-CT scan of the chest (n = 14). These patients were treated with antiarrhythmic drugs (AADs) and immunosuppression. Patients with scar related VT (without active inflammation) were managed with AADs and underwent radiofrequency ablation (RFA) if unresponsive to drug therapy (n = 4). Patients previously treated for CS who presented with VT and evidence of reactivation (abnormal FDG uptake) after a quiescent period of 6 months were treated with intensified immunosuppression alongside AADs (n = 3/14). Patients with myocardial inflammation responded well to immunosuppression. Patients with drug resistant VT in the scar phase responded well to RFA. Four patients in the inflammatory group had recurrence of VT during follow-up of whom 3 were found to have disease reactivation. Intensified immunosuppression suppressed VT in all 3 patients. In 1 patient, VT recurrence was found to be scar related and required RFA for control.
Tailoring therapy for VT in CS according to the phase of disease results in good clinical outcome and avoids unnecessary immunosuppression.
治疗心脏结节病（CS）患者的室性心动过速（VT）具有挑战性，因为患者处于疾病的不同阶段（炎症期、瘢痕期，或有时两者皆有）。为了获得更好的治疗效果，需要采用定制化的治疗方法。我们描述了基于疾病阶段对CS患者VT进行管理的经验。
如果胸部PET-CT扫描显示心肌氟脱氧葡萄糖（FDG）摄取增加，则认为患者存在心肌炎症（n = 14）。这些患者接受抗心律失常药物（AADs）和免疫抑制治疗。与瘢痕相关的VT患者（无活动性炎症）接受AADs治疗，若对药物治疗无反应则接受射频消融（RFA）治疗（n = 4）。既往接受过CS治疗且在6个月静止期后出现VT并有再激活证据（FDG摄取异常）的患者，在使用AADs的同时接受强化免疫抑制治疗（n = 3/14）。有心肌炎症的患者对免疫抑制治疗反应良好。瘢痕期对药物耐药的VT患者对RFA反应良好。炎症组有4例患者在随访期间VT复发，其中3例被发现疾病再激活。强化免疫抑制治疗使所有3例患者的VT得到抑制。在1例患者中，发现VT复发与瘢痕有关，需要进行RFA来控制。
根据疾病阶段为CS患者的VT量身定制治疗方案可取得良好的临床效果，并避免不必要的免疫抑制。
