Ventricular Arrhythmias in Patients with Cardiac Sarcoidosis

概要

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Background: Sarcoidosis is a systemic syndrome of unknown etiology and cardiac involvements are important prognostic factors in this disease. Corticosteroid has been widely used but anti-tachyarrhythmic effect was limited. Several pharmacologic and antiarrhythmic devices (ICD/CRTD) were used but little is known about the factors associated with the development of ventricular tachycardia/ventricular fibrillation (VT/VF). Method: Total one-hundred ninety Japanese patients with cardiac sarcoidosis (clinical diagnosis in 82, and biopsy proven in 108 cases, M/F=58⁄132, age 62.4±12.1 years and mean follow-up 5.1 years) were collected from 43 hospitals. Mean left ventricular ejection fraction (EF) at diagnosis was 42.0±17.4% and corticosteroids was administered in 140 cases (74%). Sustained VT/VF was documented in 30 cases (16%), ICD/CRTD was implanted in 60 (45/15) cases and antiarrhythmic drugs were used in 74 (amiodaron in 41, sotalol in 14 and Na blocker in 27). Results: Sustained VT/VF was more observed in low EF patients (25% in EF<0.35 and 10% in EF>0.35, P<0.05). Corticosteroid did not reduce VT/VF episodes but significantly improved AV block in 28 cases (19%). Efficiency of antiarrhythmic drugs were amiodarone in 73%, sotalol in 57% and Na blockers in 50%. Conclusion: Sustained VT/VF is commonly observed in cardiac sarcoidosis. Defibrillation device with amiodarone should be considered in patients with decreased cardiac function.