Kim B Michelle, Sykora Daniel, Rosenbaum Andrew N, Ahmed Enas, Churchill Robert A, Bratcher Melanie, Elwazir Mohamed Y, Bois John P, Giudicessi John R, Sugrue Alan M, Killu Ammar M, Kapa Suraj, Deshmukh Abhishek J, Asirvatham Samuel J, Cooper Leslie T, Abou Ezzeddine Omar F, Siontis Konstantinos C
Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Heart Rhythm. 2025 May;22(5):1312-1320. doi: 10.1016/j.hrthm.2024.08.049. Epub 2024 Aug 28.
Current guidelines present varying classes of recommendations for implantable cardioverter-defibrillator (ICD) utilization in patients with cardiac sarcoidosis (CS) and left ventricular ejection fraction (LVEF) <50%.
The purpose of this study was to investigate the ventricular arrhythmia risk in CS patients with ICDs and varying degrees of left ventricular systolic dysfunction.
The study included CS patients with an ICD and LVEF <50% at index evaluation. The primary outcome was survival free of sustained ventricular tachycardia (VT)/ventricular fibrillation (VF) after ICD implantation and was assessed comparatively for LVEF ≤35% vs 36%-49% and for primary vs secondary prevention ICD indication.
The study included 61 patients (median age 57 years; 61% male) with LVEF 36%-49% (n = 23) or LVEF ≤35% (n = 38). An ICD was implanted for secondary prevention in 24% and 44% of the LVEF ≤35% and 36%-49% groups, respectively (P = .11). The primary outcome did not differ between the 2 groups in univariable analysis (LVEF ≤35% vs 36%-49%: hazard ratio [HR] 0.85; 95% confidence interval [CI] 0.39-1.82; P = .67). In multivariable analysis, secondary prevention ICD indication was the only significant predictor of incident sustained VT/VF (HR 2.86; 95% CI 1.23-6.67; P = .015). Mean sustained VT/VF event burden was higher in the secondary compared with the primary prevention ICD patients (0.47 vs 0.11 events per patient-year; P = .005) but did not differ significantly between LVEF ≤35% and 36%-49% patients.
CS patients with ICD indications and LVEF 36%-49% carry similarly high arrhythmic risk as those with LVEF ≤35%. Patients with secondary prevention ICDs have the highest overall risk.
当前指南针对心脏结节病（CS）且左心室射血分数（LVEF）<50%的患者使用植入式心脏复律除颤器（ICD）给出了不同类别的推荐。
本研究旨在调查植入ICD且存在不同程度左心室收缩功能障碍的CS患者发生室性心律失常的风险。
本研究纳入在首次评估时植入ICD且LVEF<50%的CS患者。主要结局为ICD植入后无持续性室性心动过速（VT）/心室颤动（VF）存活，并对LVEF≤35%与36%-49%以及一级预防与二级预防ICD适应症的情况进行比较评估。
本研究纳入61例患者（中位年龄57岁；61%为男性），LVEF为36%-49%（n = 23）或LVEF≤35%（n = 38）。LVEF≤35%和36%-49%组分别有24%和44%的患者因二级预防植入ICD（P = 0.11）。在单变量分析中，两组的主要结局无差异（LVEF≤35%与36%-49%：风险比[HR]0.85；95%置信区间[CI]0.39-1.82；P = 0.67）。在多变量分析中，二级预防ICD适应症是发生持续性VT/VF的唯一显著预测因素（HR 2.86；95% CI 1.23-6.67；P = 0.015）。与一级预防ICD患者相比，二级预防ICD患者的平均持续性VT/VF事件负担更高（每位患者每年0.47次事件与0.11次事件；P = 0.005），但LVEF≤35%和36%-49%的患者之间无显著差异。
有ICD适应症且LVEF为36%-49%的CS患者与LVEF≤35%的患者具有相似的高心律失常风险。二级预防ICD患者的总体风险最高。
