Takaya Yoichi, Kusano Kengo, Nishii Nobuhiro, Nakamura Kazufumi, Ito Hiroshi
Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Int J Cardiol. 2017 Aug 1;240:302-306. doi: 10.1016/j.ijcard.2017.04.044. Epub 2017 Apr 19.
Little is known about the suitability of implantable cardioverter defibrillator (ICD) implantation in patients with cardiac sarcoidosis (CS). We evaluated the efficacy of ICD implantation in patients with CS, including suspected CS, compared with those with idiopathic dilated cardiomyopathy (DCM).
A total of 102 consecutive patients with definite CS, suspected CS, or DCM who underwent ICD implantation were enrolled. The endpoint was the first documentation of appropriate ICD therapy for ventricular tachyarrhythmias. The follow-up started after ICD implantation.
Appropriate ICD therapies occurred in 15 (56%) of 27 patients with definite CS, 17 (68%) of 25 with suspected CS, and 16 (32%) of 50 with DCM. The rate of appropriate ICD therapies was higher in patients with definite CS and those with suspected CS than in those with DCM (log-rank test, p=0.010). After ICD implantation, five or more appropriate ICD therapies occurred in 5 (19%) patients with definite CS and 10 (40%) with suspected CS, but in only 1 (2%) with DCM. Cox proportional hazard analysis showed that CS, including suspected CS, was independently associated with appropriate ICD therapies. For primary prevention, the rate of appropriate ICD therapies was higher in patients with CS than in those with DCM (log-rank test, p=0.034). More than half of patients with CS received appropriate ICD therapies.
Patients with CS receive appropriate ICD therapies for ventricular tachyarrhythmias at a higher rate, compared with those with DCM, suggesting that ICD implantation should be performed in patients with CS.
关于植入式心脏复律除颤器（ICD）植入在心脏结节病（CS）患者中的适用性知之甚少。我们评估了ICD植入在CS患者（包括疑似CS患者）中的疗效，并与特发性扩张型心肌病（DCM）患者进行了比较。
连续纳入102例接受ICD植入的确诊CS、疑似CS或DCM患者。终点是首次记录到针对室性快速心律失常的适当ICD治疗。随访从ICD植入后开始。
27例确诊CS患者中有15例（56%）、25例疑似CS患者中有17例（68%）、50例DCM患者中有16例（32%）接受了适当的ICD治疗。确诊CS患者和疑似CS患者的适当ICD治疗率高于DCM患者（对数秩检验，p=0.010）。ICD植入后，5例（19%）确诊CS患者和10例（40%）疑似CS患者发生了5次或更多次适当的ICD治疗，但DCM患者中只有1例（2%）发生了这种情况。Cox比例风险分析表明，CS（包括疑似CS）与适当的ICD治疗独立相关。对于一级预防，CS患者的适当ICD治疗率高于DCM患者（对数秩检验，p=0.034）。超过一半的CS患者接受了适当的ICD治疗。
与DCM患者相比，CS患者因室性快速心律失常接受适当ICD治疗的比例更高，这表明CS患者应进行ICD植入。
