Recovery of atrioventricular block following steroid therapy in patients with cardiac sarcoidosis

Yodogawa, Kenji; Seino, Yoshihiko; Shiomura, Reiko; Takahashi, Katsumi; Tsuboi, Ippei; Uetake, Shunsuke; Hayashi, Hiroshi; Horie, Tsutomu; Iwasaki, Yu; Hayashi, Meiso; Miyauchi, Yasushi; Shimizu, Wataru

doi:10.1016/j.jjcc.2013.07.007

Cited by 56 publications

(39 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Immunosuppressive therapy with systemic corticosteroids and other immunomodulators is the current standard treatment (25,(31)(32)(33). Because of the critical nature of reentrant arrhythmias and the increased risk for sudden cardiac death, some experts advocate early use of implantable cardiac devices, particularly defibrillators, in patients with biopsy-proved systemic sarcoidosis and positive cardiac imaging results (27,34).…”

Section: Therapymentioning

confidence: 99%

Cardiac Sarcoidosis: The Challenge of Radiologic-Pathologic Correlation:From the Radiologic Pathology Archives

Jeudy¹,

Burke²,

White³

et al. 2015

RadioGraphics

View full text Add to dashboard Cite

Cardiac sarcoidosis is a rare but potentially fatal disorder with a nonspecific spectrum of clinical manifestations, including conduction disorders, congestive heart failure, ventricular arrhythmias, and sudden cardiac death. Although early treatment to improve morbidity and mortality is desirable, sensitive and accurate detection of cardiac sarcoidosis remains a challenge. Except for the histopathologic finding of noncaseating granulomas in an endomyocardial biopsy specimen, most diagnostic tests are limited and nonspecific at best. Therefore, the decision to initiate treatment is based largely on the patient's clinical symptoms and the course of the disease, rather than histologic confirmation. Successful recognition of cardiac sarcoidosis ultimately requires rigorous collaboration among a clinician, radiologist, and pathologist. Advanced imaging modalities, such as cardiac magnetic resonance imaging and positron emission tomography with fluorodeoxyglucose, have become increasingly useful in facilitating diagnosis and therapeutic monitoring, although limited prospective studies exist. This article describes the clinical parameters and pathologic findings of cardiac sarcoidosis and the advanced imaging features and differential diagnostic challenges that must be considered for a successful diagnostic approach. In addition, to improve the understanding of abnormalities detected with different imaging modalities, we suggest a unified terminology in describing radiologic findings related to cardiac sarcoidosis.

show abstract

Section: Therapymentioning

confidence: 99%

Cardiac Sarcoidosis: The Challenge of Radiologic-Pathologic Correlation:From the Radiologic Pathology Archives

Jeudy¹,

Burke²,

White³

et al. 2015

RadioGraphics

View full text Add to dashboard Cite

show abstract

“…Specifically, the immediate prescription of corticosteroids can effect recovery of atrioventricular (AV) block,77 94 95 and improve survival 13. Patients presenting with syncope, out-of-hospital arrest or malignant rhythm disturbance need consideration for urgent device therapy, involving either pacemaker or defibrillator implantation.…”

Section: Managementmentioning

confidence: 99%

“…A steroid regimen might initially consist of 30–40 mg of prednisolone daily,1 95 100 106 falling in stages over a 2-month period to a maintenance dose of 10–15 mg per day 11. Around 58% of experts have indicated an initiating dose of prednisolone of ≤40 mg/day, and the majority would use the same regimen regardless of the indication (arrhythmia or cardiomyopathy) 1.…”

Section: Managementmentioning

confidence: 99%

Cardiac sarcoidosis: diagnosis and management

Dubrey

Sharma

Underwood

et al. 2015

Postgraduate Medical Journal

View full text Add to dashboard Cite

Cardiac sarcoidosis is one of the most serious and unpredictable aspects of this disease state. Heart involvement frequently presents with arrhythmias or conduction disease, although myocardial infiltration resulting in congestive heart failure may also occur. The prognosis in cardiac sarcoidosis is highly variable, which relates to the heterogeneous nature of heart involvement and marked differences between racial groups. Electrocardiography and echocardiography often provide the first clue to the diagnosis, but advanced imaging studies using positron emission tomography and MRI, in combination with nuclear isotope perfusion scanning are now essential to the diagnosis and management of this condition. The identification of clinically occult cardiac sarcoidosis and the management of isolated and/or asymptomatic heart involvement remain both challenging and contentious. Corticosteroids remain the first treatment choice with the later substitution of immunosuppressive and steroid-sparing therapies. Heart transplantation is an unusual outcome, but when performed, the results are comparable or better than heart transplantation for other disease states. We review the epidemiology, developments in diagnostic techniques and the management of cardiac sarcoidosis.

show abstract

“…However, the study performed in Japan concluded that there was no significant difference in the prognosis in patients treated with a high initial dose (>30 mg) as compared to a low initial dose (≤30 mg) of prednisone [17]. Early use of corticosteroids can allow recovery of AV block and improve left ventricular ejection fraction [18,19]. Steroids are less effective against ventricular arrhythmias, which most commonly are related to scar formation [20].…”

Section: Steroidsmentioning

confidence: 99%

Cardiac sarcoidosis – management and prognosis (RCD code: III-3A.3)

Błaut-Jurkowska

Kaźnica-Wiatr²,

Knap³

et al. 2017

Journal of Rare Cardiovascular Diseases

View full text Add to dashboard Cite

Sarcoidosis is a systemic, granulomatous disease of unknown etiology. Cardiac involvement in the course of sarcoidosis occurs in 5% of patients. However, about 25% of patient with systemic/pulmonary sarcoidosis might present with asymptomatic myocardial injury. The main manifestations of cardiac sarcoidosis are conduction abnormalities, ventricular arrhythmias and heart failure. Diagnosis of cardiac sarcoidosis remains a challenge for physicians. Treatment should be introduced at the time of diagnosis to prevent potentially lethal progression of cardiac disease. Steroids are the first drugs of choice. Additional anti-sarcoidosis agents are used as alternatives or to reduce the steroids dose. Some patients require implantation of a cardioverter-defibrillator for the prevention of sudden cardiac death. Patients with refractory ventricular tachyarrhythmia or severe, intractable heart failure unresponsive to optimal pharmacotherapy, require heart transplantation. Prognosis in cardiac sarcoidosis is highly variable, dependent on location and severity of heart involvement. This article reviews current diagnostic and therapeutic recommendations for cardiac sarcoidosis. JRCD 2017; 3 (2): 37-43

show abstract

Recovery of atrioventricular block following steroid therapy in patients with cardiac sarcoidosis

Abstract: Early initiation of steroid therapy may be effective for AV block, and steroid therapy before device implantation is a possible therapeutic strategy for some selected patients.

Cited by 56 publications

References 27 publications

Cardiac Sarcoidosis: The Challenge of Radiologic-Pathologic Correlation:From the Radiologic Pathology Archives

Cardiac Sarcoidosis: The Challenge of Radiologic-Pathologic Correlation:From the Radiologic Pathology Archives

Cardiac sarcoidosis: diagnosis and management

Cardiac sarcoidosis – management and prognosis (RCD code: III-3A.3)

Contact Info

Product

Resources

About