ElRefai Mohamed, Menexi Christina, Roberts Paul R
Cardiology Department, University Hospital of Cambridge, Cambridge, UK.
Cardiology Department, Essex Cardiothoracic Centre, Essex, UK.
J Innov Card Rhythm Manag. 2024 Nov 15;15(11):6088-6094. doi: 10.19102/icrm.2024.15115. eCollection 2024 Nov.
Sarcoidosis is a complex disease characterized by inflammatory granulomas that can affect various organs, including the heart. The diagnosis of cardiac sarcoidosis poses challenges, and current criteria involve the use of advanced imaging techniques and histological confirmation. Clinical manifestations of cardiac sarcoidosis vary widely, ranging from heart block to ventricular tachycardia and heart failure. Sudden cardiac death (SCD) is a significant concern, and implantable cardioverter-defibrillators (ICDs) are recommended for preventing SCD in high-risk cases. However, some patients with cardiac sarcoidosis do not meet the current guidelines for ICD implantation, leaving them at risk. Traditional transvenous ICDs are associated with complications, especially in immunosuppressed patients. The subcutaneous implantable cardioverter-defibrillator (S-ICD) offers a potential solution, as it avoids vascular complications and reduces the risk of infections. However, concerns regarding inappropriate shocks and the lack of pacing therapy limit its widespread use. Leadless pacing combined with S-ICD represents a potential novel approach to managing cardiac sarcoidosis patients. Ongoing human clinical trials are expected to shed light on the safety and efficacy of this combined therapy. Cardiac sarcoidosis patients, who have been underserved by traditional device therapies, may benefit from this personalized approach. Further research is needed to guide the management of SCD risk in this population.
结节病是一种复杂的疾病，其特征为炎症性肉芽肿，可累及包括心脏在内的各种器官。心脏结节病的诊断具有挑战性，目前的标准包括使用先进的成像技术和组织学确认。心脏结节病的临床表现差异很大，从心脏传导阻滞到室性心动过速和心力衰竭。心源性猝死（SCD）是一个重大问题，对于高危病例，建议使用植入式心脏复律除颤器（ICD）来预防SCD。然而，一些心脏结节病患者不符合目前ICD植入的指南，使他们处于风险之中。传统的经静脉ICD会引发并发症，尤其是在免疫抑制患者中。皮下植入式心脏复律除颤器（S-ICD）提供了一种潜在的解决方案，因为它避免了血管并发症并降低了感染风险。然而，对不适当电击的担忧以及缺乏起搏治疗限制了其广泛应用。无导线起搏与S-ICD相结合代表了一种治疗心脏结节病患者的潜在新方法。正在进行的人体临床试验有望阐明这种联合治疗的安全性和有效性。传统设备疗法服务不足的心脏结节病患者可能会从这种个性化方法中受益。需要进一步研究以指导该人群中SCD风险的管理。
