Abstract 3879: Predictor of Occurrence of Congestive Heart Failure and Upgrade to Cardiac Resynchronisation Therapy Device in Patients With Cardiac Sarcoidosis Implanted Pacemaker and Implantable Cardioverter-Defibrillator
Purpose: Cardiac sarcoidosis can produce atrioventricular block (AVB) and ventricular tachyarrhythmia (VT), and require implantation of a permanent pacemaker (PPM) or an implantable cardioverter-defibrillator (ICD). In addition, some patients undergo upgrade from PPM and ICD to cardiac resynchronisation therapy (CRT) pacemaker/defibrillator (CRT-P/CRT-D) because of congestive heart failure (CHF). The purpose of this study is to determine the predictors of the occurrence of CHF and upgrade to CRT devices in patients with cardiac sarcoidosis implanted PPMs and ICDs.
Materials and Methods: 23 patients (5 male, mean age of 60±8 years), who underwent cardiac device implantation (12 PPMs, 8 ICDs, and 3 CRT-Ds), were included. The 3 patients with CRT-Ds had no episode of CHF after device implantation. Logistic regression models were made to predict the occurrence of CHF and upgrade to CRT devices in the 20 patients with PPMs and ICDs, using age, gender, corticosteroid therapy, and cumulative percent ventricular pacing (%).
Results: During a mean follow-up of 55±44 months, in the 12 patients with PPMs, 1 patient (8.3%) underwent upgrade to a CRT-P and 2 patients (16.7%) had hospitalizations due to CHF but did not undergo upgrade of devices. 2 (25.0%) of the 8 patients with ICDs underwent upgrade to CRT-Ds. The mean LVEF was significantly lower in the patients with CHF and upgrade of devices than in those without (38±19% vs. 59±12%, p=0.044). Corticosteroid was administered to 11 patients (70%) in the patients with CHF and upgrade of devices and 3 patients (60%) in those without. In logistic regression models, a significant predictor of the occurrence of CHF and upgrade to CRT devices was left ventricular ejection fraction (LVEF) at the time of device implantation (relative risks, 0.8952; 95% confidence intervals, 0.8039 – 0.9969). Corticosteroid therapy and cumulative percent ventricular pacing were not significant predictors.
Conclusions: Cardiac sarcoidosis in patients with PPMs and ICDs due to AVB and VT might progress to CHF when the LVEF was lower at the time of device implantation. Therefore, the implantation of CRT-P/CRT-D should be firstly considered in cardiac sarcoidosis patients with LV dysfunction.