Background

Risk stratification for sudden cardiac death (SCD) in cardiac sarcoidosis (CS) is challenging in patients without overt cardiac symptoms.

Objective

The purpose of this study was to determine the incidence of ventricular arrhythmias (VAs) and mortality after long-term monitoring with a cardiovascular implantable electronic device (CIED) in CS patients identified after systematic screening of patients with extracardiac sarcoidosis (ECS).

Methods

A retrospective study was performed in 547 predominantly Caucasian patients with ECS screened for cardiac involvement. If CS was diagnosed, risk stratification (high vs low risk) for SCD was performed by a multidisciplinary team. The primary endpoint was defined as sustained VA, appropriate implantable cardioverter-defibrillator (ICD) therapy, or cardiac death.

Results

In total, 105 patients were included (mean follow-up 33 ± 16 months). An ICD was implanted in 17 high-risk patients (16.2%), whereas 80 low-risk patients (76.1%) received an implantable loop recorder (ILR). Eight low-risk patients (7.6%) did not receive a device. The primary endpoint occurred in 4.8% (n = 5), with an overall annualized event rate of 1.7%. The annualized event rate was 9.8% in high-risk patients and 0.4% in low-risk patients. Nine low-risk patients received an ICD during follow-up, in 7 patients as a result of the ILR recordings. None of these patients required ICD therapy.

Conclusion

In CS patients without overt cardiac symptoms at initial presentation the annualized overall event rate was 1.7%; 10% in high-risk patients, but only 0.4% in low-risk patients. In low-risk patients long-term arrhythmia monitoring with an ILR enabled early detection of clinically important arrhythmias without showing impact on prognosis.

中文翻译：

---

心脏结节病患者使用心血管植入式电子设备长期监测心律失常

背景

在没有明显心脏症状的患者中，心脏结节病 (CS) 中心脏性猝死 (SCD) 的风险分层具有挑战性。

客观的

本研究的目的是确定在对心外结节病 (ECS) 患者进行系统筛查后确定的 CS 患者中，使用心血管植入式电子设备 (CIED) 进行长期监测后室性心律失常 (VAs) 的发生率和死亡率。

方法

一项回顾性研究对 547 名主要为白种人的 ECS 患者进行了心脏受累筛查。如果诊断出 CS，则由多学科团队对 SCD 进行风险分层（高风险与低风险）。主要终点定义为持续 VA、适当的植入式心脏复律除颤器 (ICD) 治疗或心源性死亡。

结果

总共包括 105 名患者（平均随访 33 ± 16 个月）。17 名高危患者 (16.2%) 植入了 ICD，而 80 名低危患者 (76.1%) 接受了植入式循环记录器 (ILR)。8 名低风险患者 (7.6%) 未接受设备。主要终点发生率为 4.8%（n = 5），总体年化事件率为 1.7%。高风险患者的年化事件发生率为 9.8%，低风险患者为 0.4%。9 名低风险患者在随访期间接受了 ICD，其中 7 名患者是 ILR 记录的结果。这些患者均不需要 ICD 治疗。

结论

在最初就诊时没有明显心脏症状的 CS 患者中，年化总事件发生率为 1.7%；在高危患者中为 10%，但在低危患者中仅为 0.4%。在低风险患者中，使用 ILR 进行长期心律失常监测能够早期发现临床上重要的心律失常，而不会影响预后。