Factors associated with implantable cardioverter defibrillators appropriate therapy in cardiac sarcoidosis: a
Levi-Dan Azoulay1, Xavier Waintraub2, Julien Haroche1
1Sorbonne Université, INSERM UMRS-1135, CIMI, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares, Hôpital Pitié-Salpêtrière, 75013-Paris, France.
Insights
Patients with cardiac sarcoidosis receiving implantable cardioverter-defibrillator (ICD) therapy are more likely to experience appropriate shocks if they are younger, male, and have reduced left ventricular ejection fraction (LVEF). These factors, along with complete heart block and ventricular pacing, predict therapy needs in cardiac sarcoidosis patients.
Area of Science:
- Cardiology
- Electrophysiology
- Immunology
Background:
- Cardiac sarcoidosis (CS) presents a significant risk for patients, leading to atrioventricular blocks, ventricular arrhythmias, and sudden cardiac death.
- Understanding predictors of appropriate therapy in implantable cardioverter-defibrillator (ICD) patients with CS is crucial for risk stratification and management.
Purpose of the Study:
- To investigate patient characteristics associated with appropriate ICD therapy in individuals diagnosed with cardiac sarcoidosis.
Main Methods:
- A systematic literature search was conducted using PubMed and Web of Science databases.
- Studies reporting on CS patients who underwent ICD implantation were included, with appropriate therapy as the primary outcome.
- A meta-analysis was performed on data from 5 selected studies, encompassing 464 patients.
Main Results:
- The meta-analysis included 464 patients (mean age 55 years, 60% male) with a mean follow-up of 3.5 years.
- Appropriate ICD therapy was observed in 39% (180 patients).
- Factors associated with appropriate therapy included younger age, male sex, lower left ventricular ejection fraction (LVEF), complete heart block, and ventricular pacing.
Conclusions:
- Appropriate ICD therapy in cardiac sarcoidosis patients is significantly associated with younger age, male sex, and reduced LVEF.
- A history of complete heart block and the presence of ventricular pacing are also linked to receiving appropriate ICD therapy.
- These findings aid in identifying CS patients who may benefit most from ICDs and require closer monitoring.
Background:
Patients with cardiac sarcoidosis (CS) are at increased risk of atrioventricular blocks, ventricular arrhythmias, and sudden cardiac death. Objectives We aimed to investigate the characteristics associated with appropriate therapy in implantable cardiac defibrillator (ICD) -implanted CS patients.
Methods:
We performed a PubMed and Web of Science search for studies reporting patients with CS who underwent an ICD implantation. The primary criterion was an appropriate therapy.
Results:
We screened 705 studies, of which 5 were included in the final analysis. We conducted a meta-analysis including 464 patients (mean age 55 years, 282 males (60%)). The mean follow-up was 3.5 years. Among the 464 patients, 180 received an appropriate therapy (39%). Patients who received an appropriate therapy were younger (-3.33, 95% confidence interval (CI) -6.42 to -0.23, p=0.004), were more likely to be male (OR 2.06, 95% CI 1.37-3.09, p=0.0005), had a lower left ventricular ejection fraction (LVEF) (-10.5, 95% CI -18.23 to -2.78, p=0.008), had a higher rate of complete heart block (OR 2.19, 95% CI 1.20 to 3.99, p=0.01), and more frequently had ventricular pacing (OR 6.44 95% CI 2.57 to 16.16, p<0.0001).
Conclusions:
Appropriate ICD therapy during CS is associated with young age, male sex, low LVEF, history of complete heart block, and ventricular pacing. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (1): 17-23).
Related Concept Videos
01:29Cardiomyopathy V: Interprofessional Care
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Cardiomyopathy IV: Restrictive Cardiomyopathy
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:14Myocarditis III: Medical Management
01:22Heart Failure VI: Adjunct Therapies