Abstract 2294: Steroid Therapy Improves Atrioventricular Conduction Disturbance but not Ventricular Arrhythmia in Active Phase of Cardiac Sarcoidosis
(Backgrounds) Ventricular arrhythmias and conduction disturbance is frequently observed in cardiac sarcoidosis (CS) and corticosteroids have been commonly used in CS. However, there are very few reports regarding CS activity and arrhythmic events.
(Methods) Nineteen CS patients were studied (M/F=8/11, mean age 58.5±11.5yrs. old). The diagnosis of CS was made according to the criteria developed by the Specific Diffuse Pulmonary Disease Research Group, Sarcoidosis Division of the Japanese Ministry of Health, Labor, and Welfare. Active CS was evaluated by the result of Gallium-67-citrate scintigraphy (GA) and arrhythmic events were evaluated by repeated Holter recordings. All positive GA patients were treated with oral steroids.
(Results) Total 16 arrhythmic events in 14 patients were evaluated: 6 complete atrioventricular block (CAVB), 7 ventricular tachycardia and 3 frequent ventricular premature contractions (VPCs). Nine patients had positive GA. Interestingly positive GA was observed in all CAVB patients but one (11%) of 9 ventricular arrhythmia patient (p<0.05). Steroid therapy abolished GA uptake in all patients. Holter recording showed that steroid therapy improved AV conduction in 3 (50%) of 6 CAVB patients (grade 3 to 2, p=0.07) but not decreased the occurrences of VPCs (before 74±79/hour vs. after 139±123/hour, NS). In 3 (33%) of 9 patients, steroids worsened the severity of Lown grade: grade 0 to grade 1 in one patient and grade 1 to 2 in 2.
(Conclusions) In CS, CAVB occurs mainly in active phase and early management of steroids can improve the atrioventricular conduction disturbance. Ventricular arrhythmias are not closely linked the disease activity ,but steroids sometimes deteriorate ventricular arrhythmias.