Abstract 15441: Effect of Corticosteroid Therapy on Ventricular Arrhythmias in Patients with Cardiac Sarcoidosis
Background: Ventricular arrhythmias are one of the main causes of sudden death in cardiac sarcoidosis (CS). Little is known about the efficacy of corticosteroid therapy for ventricular arrhythmias in CS.
Methods: Thirty-one CS patients presenting premature ventricular contractions (PVCs,≥ 300/day) were investigated. Fourteen patients had non-sustained ventricular tachycardia (NSVT). All of patients were treated with corticosteroid, and the initial dosage is 30 mg/day of prednisone, which was tapered over a period of 6 months to a maintenance dosage of 10 mg/day. 24-hour Holter monitoring, signal averaged electrocardiography (SAECG), echocardiography, Gallium-67 scintigraphy, serum angiotensin converting enzyme (ACE) and plasma B-type natriuretic peptide (BNP) concentrations were assessed before and after corticosteroid therapy.
Results: As a whole, there were no significant differences in the number of PVCs and in the prevalence of NSVT before and after corticosteroid therapy. However, the preserved ejection fraction (EF) patients (≥35%, n=17) showed significant reduction in the number of PVCs (from 1820 +/− 2969 to 742 +/− 1425, p=0.048) and in the prevalence of NSVT (from 41 to 6%, p=0.039) after corticosteroid therapy. In these patients, EF tended to increase (from 52.4 +/− 13.2 to 55.1 +/− 12.2 %, p=0.060), ACE and BNP levels tended to decrease after corticosteroid therapy (ACE; from 17.1 +/− 7.1 to 14.4 +/− 4.6 IU/l, p=0.091 BNP; from 123.7 +/− 200.1 to 66.3 +/− 109.4 pg/ml, p=0.093). Late potentials (LP) on SAECG were abolished in 3 patients. The preserved EF group showed a significantly higher prevalence of Gallium-67 uptake compared with the reduced EF group (35.3% vs 0.0%, p<0.05). In the reduced EF patients (<35%, n=14), there were no significant differences in these parameters.
Conclusion: In the early and reversible stage, corticosteroid therapy was effective for ventricular arrhythmias in CS. However, it may be less effective in the late stage.
- © 2010 by American Heart Association, Inc.