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Pacemakers and methylprednisolone pulse therapy in immune-related myocarditis concomitant with complete heart block

Chunhong Hu1, Lishu Zhao1, Chengzhi Zhou2

  • 1Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.

Open Medicine (Warsaw, Poland)
|December 30, 2022
PubMed

Insights

Pacemakers and methylprednisolone pulse therapy (MPPT) improve survival for patients with immune-related myocarditis and complete heart block (CHB). Early pacemaker implantation is crucial for better outcomes in these rare but serious conditions.

Area of Science:

  • Oncology
  • Cardiology
  • Immunology

Background:

  • Immune-related cardiotoxicities, though uncommon, can be fatal.
  • Immune-related myocarditis, particularly when concomitant with complete heart block (CHB), presents a significant clinical challenge.

Purpose of the Study:

  • To evaluate the efficacy of pacemakers and methylprednisolone pulse therapy (MPPT) in managing immune-related myocarditis with CHB.
  • To analyze clinical characteristics, management strategies, and outcomes in affected patients.

Main Methods:

  • Review of medical records for three patients with immune-related myocarditis and CHB.
  • PubMed database search for related cases, followed by screening and data summarization.
  • Pooled analysis comparing outcomes based on pacemaker implantation and MPPT.

Main Results:

  • Patients receiving pacemakers showed a significantly lower fatality rate (38%) compared to those without (100%; p=0.035).
  • The methylprednisolone pulse therapy (MPPT) subgroup also demonstrated a reduced fatality rate (25% vs 100%; p=0.019).
  • All patients without pacemakers expired, highlighting the critical role of pacing.

Conclusions:

  • Timely pacemaker implantation is vital for improving survival in immune-related myocarditis with CHB.
  • Methylprednisolone pulse therapy (MPPT) may offer a better prognosis.
  • Multidisciplinary consultation is recommended for optimal patient management.

Keywords:
complete heart blockimmune checkpoint inhibitormethylprednisolone pulse therapymyocarditispacemaker

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