Abstract 14804: Time-Course and Influencing Factors of Ventricular Tachy-Arrhythmias After Initiation of Steroid Therapy in Patients With Cardiac Sarcoidosis

Abstract

Introduction: It is widely known that ventricular tachy-arrhythmias (VTs) are often observed in patients with cardiac sarcoidosis (CS) as one of the presentations of poor prognosis. However, the time-course and influencing factors of VTs after the introduction of corticosteroid therapy in CS patients remain to be elucidated. Methods and Results: We examined the influence of steroid therapy on VTs in 68 consecutive CS patients in Tohoku University Hospital from October 1998 until September 2014 (57±11 years-old, M/F 18/50). CS was diagnosed based on the original guidelines for diagnosis of CS from the Japanese Ministry of Health and Welfare. Corticosteroid therapy was performed in all CS patients. VTs were defined as sustained ventricular tachycardia/fibrillation or appropriate ICD therapy events. During a mean follow-up of 5.5 years, 20 out of 68 patients (29%) experienced VTs after the initiation of corticosteroid therapy, and 14 (70%) of them had VTs in the first 12 months (Figure A). Multivariable analysis showed that the positive gallium scintigraphy was an independent risk factor for VTs (odds ratio, 17.4; 95% CI, 1.03-294, P=0.047). Survival free from VTs events was significantly lower in the Ga-positive group than in the Ga-negative group (P<0.001), where most of the events were developed in the early phase in the Ga-positive group (Figure B). Furthermore, electrical storm (ES) of VTs was noted in 10 patients (14.7%), and most of them (8 out of the 10 patients) had ES in the first 12 months, whereas the recurrence of ES was relatively low (Figure C). Conclusions: VTs or ES in CS patients was frequently noted in the first 12 months after initiation of corticosteroid therapy, possibly representing inflammatory conditions, for which Ga scintigraphy is useful diagnostic strategy and Ga-positive is an independent prognostic factor in CS.