Yada Hirotaka, Soejima Kyoko
Department of Cardiology, National Defense Medical College, Tokorozawa, Japan.
Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan.
Korean Circ J. 2019 Feb;49(2):119-133. doi: 10.4070/kcj.2018.0432.
Sarcoidosis is a multisystem granulomatous disorder of unknown etiology. The annual incidence of systemic sarcoidosis is estimated at 10-20 per 100,000 individuals. Owing to the recent advances in imaging modalities, cardiac sarcoidosis (CS) is diagnosed more frequently. The triad of CS includes conduction abnormality, ventricular tachycardia, and heart failure. Atrial and ventricular arrhythmias are caused by either inflammation or scar formation. Inflammation should be treated with immunosuppression and antiarrhythmic agents and scar formation should be treated with antiarrhythmics and/or ablation, in addition to implantable cardioverter defibrillator (ICD) implantation, if necessary. Ablation can provide a good outcome, but it might require bipolar ablation if the critical portion is located mid-myocardium. Late recurrence might be caused by reactivation of sarcoidosis, which would need to be evaluated by positron emission tomography-computed tomography imaging. Risk of sudden cardiac death (SCD) in patients with advanced atrioventricular block is not low, and ICD implantation could be considered instead of a pacemaker. For risk stratification for SCD, late gadolinium enhancement by cardiac magnetic resonance imaging or program stimulation is often used.
结节病是一种病因不明的多系统肉芽肿性疾病。系统性结节病的年发病率估计为每10万人中有10 - 20例。由于成像技术的最新进展，心脏结节病（CS）的诊断更为频繁。CS的三联征包括传导异常、室性心动过速和心力衰竭。房性和室性心律失常是由炎症或瘢痕形成引起的。炎症应采用免疫抑制和抗心律失常药物治疗，瘢痕形成除必要时植入植入式心脏复律除颤器（ICD）外，应采用抗心律失常药物和/或消融治疗。消融可以取得良好的效果，但如果关键部位位于心肌中层，可能需要双极消融。晚期复发可能由结节病的重新激活引起，这需要通过正电子发射断层扫描 - 计算机断层扫描成像进行评估。晚期房室传导阻滞患者的心脏性猝死（SCD）风险不低，可以考虑植入ICD而非起搏器。对于SCD的风险分层，通常使用心脏磁共振成像的延迟钆增强或程序刺激。
