Takaya Yoichi, Nakagawa Koji, Miyoshi Toru, Nishii Nobuhiro, Morita Hiroshi, Nakamura Kazufumi, Yuasa Shinsuke
Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Am J Cardiol. 2025 Mar 1;238:65-69. doi: 10.1016/j.amjcard.2024.12.002. Epub 2024 Dec 9.
Although isolated cardiac sarcoidosis (CS) is not uncommon, little is known about the risk of life-threatening ventricular tachyarrhythmia. We aimed to evaluate the incidence of ventricular tachyarrhythmia in patients with isolated CS. A total of 94 patients with CS were enrolled. Isolated CS was diagnosed by histologic or clinical confirmation in the heart alone. The end points were sudden cardiac death, ventricular fibrillation, sustained ventricular tachycardia, or implantable cardioverter-defibrillator therapy for ventricular fibrillation or sustained ventricular tachycardia. A total of 25 patients were diagnosed with isolated CS, and 69 were diagnosed with CS with extracardiac involvement. As the initial cardiac manifestation leading to the CS diagnosis, 10 patients (40%) with isolated CS had ventricular tachyarrhythmia. Over the median follow-up of 48 months after the CS diagnosis, sudden cardiac death occurred in 2 patients (8%) with isolated CS. Ventricular fibrillation or sustained ventricular tachycardia, including implantable cardioverter-defibrillator therapy, occurred in 15 patients (60%) with isolated CS and 13 (19%) with CS with extracardiac involvement. The rate of ventricular tachyarrhythmia was higher in patients with isolated CS than in those with CS with extracardiac involvement (log-rank, p <0.01). Cox proportional hazard analysis showed that isolated CS was independently associated with ventricular tachyarrhythmia. A total of 2 or more ventricular tachyarrhythmias more frequently occurred in patients with isolated CS (52% vs 13%, p <0.01). Electric storm more frequently occurred in patients with isolated CS (24% vs 6%, p = 0.01). In conclusion, patients with isolated CS have ventricular tachyarrhythmia at a higher rate than those with CS with extracardiac involvement.
尽管孤立性心脏结节病（CS）并不少见，但对于危及生命的室性快速心律失常的风险却知之甚少。我们旨在评估孤立性CS患者室性快速心律失常的发生率。共纳入94例CS患者。孤立性CS通过仅在心脏的组织学或临床确诊。终点事件为心源性猝死、心室颤动、持续性室性心动过速，或因心室颤动或持续性室性心动过速接受植入式心脏复律除颤器治疗。共25例患者被诊断为孤立性CS，69例被诊断为合并心外受累的CS。作为导致CS诊断的初始心脏表现，10例（40%）孤立性CS患者出现室性快速心律失常。在CS诊断后的中位随访48个月期间，2例（8%）孤立性CS患者发生心源性猝死。15例（60%）孤立性CS患者和13例（19%）合并心外受累的CS患者发生心室颤动或持续性室性心动过速，包括接受植入式心脏复律除颤器治疗。孤立性CS患者的室性快速心律失常发生率高于合并心外受累的CS患者（对数秩检验，p<0.01）。Cox比例风险分析显示，孤立性CS与室性快速心律失常独立相关。2次或更多次室性快速心律失常在孤立性CS患者中更频繁发生（52%对13%，p<0.01）。电风暴在孤立性CS患者中更频繁发生（24%对6%，p = 0.01）。总之，孤立性CS患者的室性快速心律失常发生率高于合并心外受累的CS患者。
