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14-05-2022 | Sarcoidosis | Original Article

Possibility of steroid therapy without pacemaker implantation in patients with sarcoidosis presenting atrioventricular block

Authors: Kenji Yodogawa, Yuhi Fujimoto, Kanako Hagiwara, Eiichiro Oka, Hiroshi Hayashi, Hiroshige Murata, Teppei Yamamoto, Yu-ki Iwasaki, Wataru Shimizu

Published in: Heart and Vessels | Issue 11/2022

Abstract

Atrioventricular Block (AVB) is one of the common manifestations in cardiac sarcoidosis (CS). Although pacemaker implantation is generally recommended in patients with CS complicated by symptomatic AVB, some case reports have shown that they can be managed by steroid therapy without pacemaker implantation. The aim of this study was to evaluate the feasibility and effectiveness of steroid therapy without pacemaker implantation in patients with CS complicated by symptomatic AVB. We performed medical record review of consecutive ten CS patients who admitted Nippon Medical School Hospital for symptomatic second or third degree AVB between April 2015 and March 2021. Of the studied population, steroid therapy before pacemaker implantation was feasible in three patients with second degree AVB. Two of them showed subsequent recovery of atrioventricular conduction to 1:1, and they were managed by steroid therapy without pacemaker. The remaining one patient showed no improvement of atrioventricular conduction and required pacemaker implantation. Seven patients with third degree AVB required device implantation (pacemaker; n = 7, cardiac resynchronization therapy defibrillator; n = 1) before steroid therapy mainly because of hemodynamic instability. Steroid therapy without pacemaker implantation might be feasible, and possibly be effective in patients with CS presenting second degree AVB. However, the feasibility is limited in patients with third degree AVB.

Birnie DH, Sauer WH, Bogun F, Cooper JM, Culver DA, Duvernoy CS, Judson MA, Kron J, Mehta D, Cosedis Nielsen J, Patel AR, Ohe T, Raatikainen P, Soejima K (2014) HRS expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis. Heart Rhythm 11:1305–1323CrossRef

Terasaki F, Azuma A, Anzai T, Ishizaka N, Ishida Y, Isobe M, Inomata T, Ishibashi-Ueda H, Eishi Y, Kitakaze M, Kusano K, Sakata Y, Shijubo N, Tsuchida A, Tsutsui H, Nakajima T, Nakatani S, Horii T, Yazaki Y, Yamaguchi E, Yamaguchi T, Ide T, Okamura H, Kato Y, Goya M, Sakakibara M, Soejima K, Nagai T, Nakamura H, Noda T, Hasegawa T, Morita H, Ohe T, Kihara Y, Saito Y, Sugiyama Y, Morimoto SI, Yamashina A (2019) JCS 2016 Guideline on diagnosis and treatment of cardiac sarcoidosis - digest version. Circ J 83:2329–2388CrossRef

Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H (2021) JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 37:709–870CrossRef

Okamoto H, Mizuno K, Ohtoshi E (1999) Cutaneous sarcoidosis with cardiac involvement. Eur J Dermatol 9:466–469PubMed

Kato Y, Morimoto S, Uemura A, Hiramitsu S, Ito T, Hishida H (2003) Efficacy of corticosteroids in sarcoidosis presenting with atrioventricular block. Sarcoidosis Vasc Diffuse Lung Dis 20:133–137PubMed

Chapelon-Abric C, de Zuttere D, Duhaut P, Veyssier P, Wechsler B, Huong DLT, de Gennes C, Papo T, Blétry O, Godeau P, Piette JC (2004) Cardiac sarcoidosis: a retrospective study of 41 cases. Medicine (Baltimore) 83:315–334CrossRef

Banba K, Kusano KF, Nakamura K, Morita H, Ogawa A, Ohtsuka F, Ogo KO, Nishii N, Watanabe A, Nagase S, Sakuragi S, Ohe T (2007) Relationship between arrhythmogenesis and disease activity in cardiac sarcoidosis. Heart Rhythm 4:1292–1299CrossRef

Kandolin R, Lehtonen J, Kupari M (2011) Cardiac sarcoidosis and giant cell myocarditis as causes of atrioventricular block in young and middle-aged adults. Circ Arrhythm Electrophysiol 4:303–309CrossRef

Yodogawa K, Seino Y, Shiomura R, Takahashi K, Tsuboi I, Uetake S, Hayashi H, Horie T, Iwasaki YK, Hayashi M, Miyauchi Y, Shimizu W (2013) Recovery of atrioventricular block following steroid therapy in patients with cardiac sarcoidosis. J Cardiol 62:320–325CrossRef

10.

Sugishita K, Togashi Y, Aizawa A, Asakawa M, Usui S, Ito N, Yamaguchi T, Hada Y, Takahashi T (2008) Postpartum complete atrioventricular block due to cardiac sarcoidosis: steroid therapy without permanent pacemaker. Int Heart J 49:377–384CrossRef

11.

Miyazaki S, Funabashi N, Nagai T, Uehara M, Kataoka A, Takaoka H, Ueda M, Komuro I (2011) Cardiac sarcoidosis complicated with atrioventricular block and wall thinning, edema and fibrosis in left ventricle: confirmed recovery to normal sinus rhythm and visualization of edema improvement by administration of predonisolone. Int J Cardiol 150:e4–e10CrossRef

12.

Watanabe H, Eguchi K, Saitou T, Shimpo M, Hiroe M, Kario K (2016) Cardiac sarcoidosis, the complete atrioventricular block of which was completely recovered by intravenous steroid pulse therapy. J Cardiol Cases 13:21–24CrossRef

13.

Okabe T, Yakushiji T, Hiroe M, Oyama Y, Igawa W, Ono M, Kido T, Ebara S, Yamashita K, Yamamoto MH, Saito S, Hoshimoto K, Kisaki A, Isomura N, Araki H, Ochiai M (2016) Steroid pulse therapy was effective for cardiac sarcoidosis with ventricular tachycardia and systolic dysfunction. ESC Heart Fail 3:288–292CrossRef

14.

Fujimoto R, Asano T, Maezawa H, Shimojima H, Tsujiuchi M, Hori Y, Ebato M, Suzuki H (2018) Cardiac Sarcoidosis Mimicking Septal Tumor with Intermittent Complete Atrioventricular Block. Int Heart J 59:1473–1479CrossRef

15.

Ishida M, Niwano S, Fujiyoshi K, Ishida K, Ako J, Inomata T (2020) A case with recovery from high degree atrioventricular-block with steroid therapy in cardiac sarcoidosis with AH block: a possible new sign of responder? J Cardiol Cases 23:90–93CrossRef

Title: Possibility of steroid therapy without pacemaker implantation in patients with sarcoidosis presenting atrioventricular block
Authors: Kenji Yodogawa
Yuhi Fujimoto
Kanako Hagiwara
Eiichiro Oka
Hiroshi Hayashi
Hiroshige Murata
Teppei Yamamoto
Yu-ki Iwasaki
Wataru Shimizu
Publication date: 14-05-2022
Publisher: Springer Japan
Keywords: Sarcoidosis
Atrioventricular Block
Sarcoidosis
Cardiac Resynchronization Therapy
Conventional Pacemaker
Conventional Pacemaker
Pacemaker
Pacemaker
Pacemaker
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Published in: Heart and Vessels / Issue 11/2022
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI: https://doi.org/10.1007/s00380-022-02092-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Possibility of steroid therapy without pacemaker implantation in patients with sarcoidosis presenting atrioventricular block

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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