Yamada Yu, Sato Kimi, Yamamoto Masayoshi, Nabeta Takeru, Naruse Yoshihisa, Taniguchi Tatsunori, Kitai Takeshi, Yoshioka Kenji, Tanaka Hidekazu, Okumura Takahiro, Baba Yuichi, Fujimoto Yudai, Matsue Yuya, Komatsu Yuki, Nogami Akihiko, Ishizu Tomoko
Department of Cardiology, Institute of Medicine; University of Tsukuba, Tsukuba, Japan.
Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
JACC Adv. 2024 Jul 12;3(8):101105. doi: 10.1016/j.jacadv.2024.101105. eCollection 2024 Aug.
Ventricular arrhythmia (VA) is a life-threatening condition associated with cardiac sarcoidosis (CS). Right bundle branch block (RBBB) is a common conduction disorder in CS; however, its association with VA remains unknown.
This study aimed to investigate the relationship between RBBB and VA in patients with CS.
This was a post hoc analysis of ILLUMINATE-CS (Illustration of the Management and Prognosis of Japanese Patients with Cardiac Sarcoidosis), a multicenter, retrospective, and observational study that evaluated the clinical characteristics and prognosis of CS. Eligible patients were divided into two groups based on the presence or absence of RBBB at the time of diagnosis. The primary outcome was serious ventricular arrhythmia events (SVAEs), defined as a combination of sudden cardiac death and documented ventricular fibrillation, sustained ventricular tachycardia, or appropriate implantable cardioverter-defibrillator therapy.
Overall, 312 patients were studied, with 155 (49.7%) patients presenting with RBBB (RBBB group). Patients in the RBBB group had a higher prevalence of basal interventricular septum (IVS) thinning and prominent late gadolinium enhancement in the basal IVS on cardiac magnetic resonance imaging than those in the non-RBBB group. During a median follow-up of 3.0 years (IQR: 1.6-6.0 years), 66 patients experienced SVAE. In multivariable Cox regression analysis, the RBBB group was independently associated with a higher incidence of SVAEs (HR: 1.93 [95% CI: 1.14-3.28]; = 0.015).
In patients with CS, RBBB was an independent predictor of SVAEs, which might reflect the specific scar distribution that is predominant in the IVS.
室性心律失常（VA）是一种与心脏结节病（CS）相关的危及生命的病症。右束支传导阻滞（RBBB）是CS中常见的传导障碍；然而，其与VA的关联仍不清楚。
本研究旨在调查CS患者中RBBB与VA之间的关系。
这是一项对ILLUMINATE-CS（日本心脏结节病患者管理与预后的例证）的事后分析，ILLUMINATE-CS是一项多中心、回顾性观察性研究，评估了CS的临床特征和预后。符合条件的患者根据诊断时是否存在RBBB分为两组。主要结局是严重室性心律失常事件（SVAEs），定义为心源性猝死与记录到的心室颤动、持续性室性心动过速或合适的植入式心脏复律除颤器治疗的组合。
总体而言，研究了312例患者，其中155例（49.7%）患者存在RBBB（RBBB组）。与非RBBB组相比，RBBB组患者在心脏磁共振成像上基底室间隔（IVS）变薄和基底IVS晚期钆增强突出的患病率更高。在中位随访3.0年（四分位间距：1.6 - 6.0年）期间，66例患者发生了SVAEs。在多变量Cox回归分析中，RBBB组与SVAEs的较高发生率独立相关（风险比：1.93 [95%置信区间：1.14 - 3.28]；P = 0.015）。
在CS患者中，RBBB是SVAEs的独立预测因素，这可能反映了IVS中占主导的特定瘢痕分布。
