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Outcome of implantable cardioverter defibrillator in cardiac sarcoidosis: a systematic review and meta-analysis

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Abstract

Purpose

Cardiac sarcoidosis is a multisystem inflammatory disorder characterized by ventricular arrhythmias. Implantable cardioverter defibrillator (ICD) is used to prevent sudden cardiac death.

Methods

We performed literature search for studies that addressed the outcome and complications of ICD in Cardiac Sarcoidosis (CS). Multiple search sites were reviewed from January 1, 2000 until December 1, 2018. We then performed a meta-analysis using a random effects model. Two investigators independently extracted the data and assessed studies’ quality.

Results

Ten studies with 585 patients qualified for the analysis. In the pooled analysis, 57% were male with mean left ventricular ejection fraction (LVEF) of 38.4%. Appropriate and inappropriate ICD treatments (AT and IAT) were reported in 39% and 15% of patients respectively over mean follow-up period of 25 months and mortality rate of 8%. A sub-analysis of four studies indicated that patients with appropriate therapy did not differ from the rest of CS population in LVEF% (mean difference (MD) = − 7.37%, 95% confidence interval (CI) − 16.89 to 2.15, p = 0.12), age (MD = − 3.87 years, 95% CI − 10.19 to 2.46, p = 0.23), primary prevention (range difference (RD) = − 0.11, 95% CI − 0.31 to 0.10, p = 0.31) or secondary prevention indication (RD = 0.09, 95% CI − 0.12 to 0.3, p = 0.37). High degree AV block was more common in patients with AT (RD = 0.07, 95% CI 0.00 to 0.14 p = 0.05).

Conclusions

ICD placement in CS is associated with high incidence of both appropriate and inappropriate therapy. High degree AV block appears to be predictive of appropriate ICD therapy.

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Abbreviations

AT:

Appropriate treatment

IAT:

Inappropriate treatment

VT:

Ventricular tachycardia

F/U:

Follow-up

LVEF:

Left ventricular ejection fraction

AAD:

Anti-arrhythmia drugs

ACCESS:

A Case Control Etiologic Study of Sarcoidosis

HF:

Heart failure

CHB:

Complete heart block

NR:

Not reported

JMHW:

Japanese Ministry of Health and Welfare Criteria

VT/VFib:

Ventricular tachycardia/ventricular fibrillation

RTS:

Retrospective study

References

  1. Hulten E, Aslam S, Osborne M, Abbasi S, Bittencourt MS, Blankstein R. Cardiac sarcoidosis-state of the art review. Cardiovasc Diagn Ther. 2016;6(1):50–63.

    PubMed  PubMed Central  Google Scholar 

  2. Heck PM, Roberts PR. The role of implantable cardiac defibrillators in cardiac sarcoidosis: saviour or sinner? Europace. 2013;15(3):309–10.

    Article  Google Scholar 

  3. Rosenthal DG, Bravo PE, Patton KK, Goldberger ZD. Management of Arrhythmias in cardiac Sarcoidosis. Clin Cardiol. 2015;38(10):635–40.

    Article  Google Scholar 

  4. Banba K, Kusano KF, Nakamura K, Morita H, Ogawa A, Ohtsuka F, et al. Relationship between arrhythmogenesis and disease activity in cardiac sarcoidosis. Heart Rhythm. 2007;4(10):1292–9.

    Article  Google Scholar 

  5. Betensky BP, Tschabrunn CM, Zado ES, Goldberg LR, Marchlinski FE, Garcia FC, et al. Long-term follow-up of patients with cardiac sarcoidosis and implantable cardioverter-defibrillators. Heart Rhythm. 2012 Jun;9(6):884–91.

    Article  Google Scholar 

  6. Yazaki Y, Isobe M, Hiroe M, Morimoto SI, Hiramitsu S, Nakano T, et al. Prognostic determinants of long-term survival in Japanese patients with cardiac sarcoidosis treated with prednisone. Am J Cardiol. 2001;88(9):1006–10.

    Article  CAS  Google Scholar 

  7. Fussner LA, Karlstedt E, Hodge DO, Fine NM, Kalra S, Carmona EM, et al. Management and outcomes of cardiac sarcoidosis: a 20-year experience in two tertiary care centres. Eur J Heart Fail. 2018;20(12):1713–20.

    Article  Google Scholar 

  8. Louise A, Lin Y-J, Chen Y-Y, Chung F-P, Chang S-L, Lo L-W, et al. Increased risk of ventricular tachycardia in patients with sarcoidosis during the very long term follow-up. Int J Cardiol. 2017;228:68–73.

    Article  Google Scholar 

  9. Salama A, Abdullah A, Wahab A, Eigbire G, Hoefen R, Alweis R. Cardiac sarcoidosis and ventricular arrhythmias. A rare association of a rare disease. A retrospective cohort study from the National Inpatient Sample and current evidence for management. Cardiol J. 2018;1(1897):5593.

    Google Scholar 

  10. Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: executive summary. Circulation. 2018;138(13):e210–71.

    PubMed  Google Scholar 

  11. Birnie DH, Sauer WH, Bogun F, Cooper JM, Culver DA, Duvernoy CS, et al. HRS expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis. Hear Rhythm. 2014;11(7):1305–23.

    Article  Google Scholar 

  12. Schuller JL, Zipse M, Crawford T, Bogun F, Beshai J, Patel AR, et al. Implantable cardioverter defibrillator therapy in patients with cardiac sarcoidosis. J Cardiovasc Electrophysiol. 2012;23(9):925–9.

    Article  Google Scholar 

  13. Mohsen A, Jimenez A, Hood RE, Dickfeld T, Saliaris A, Shorofsky S, et al. Cardiac sarcoidosis: electrophysiological outcomes on long-term follow-up and the role of the implantable cardioverter-defibrillator. J Cardiovasc Electrophysiol. 2014;25(2):171–6.

    Article  Google Scholar 

  14. Takaya Y, Kusano K, Nishii N, Nakamura K, Ito H. Early and frequent defibrillator discharge in patients with cardiac sarcoidosis compared with patients with idiopathic dilated cardiomyopathy. Int J Cardiol. 2017;240:302–6.

    Article  Google Scholar 

  15. Bandyopadhyay D, Sahoo D, Zein J, Brunken RC, Tchou PJ, Culver DA. Outcome of cardiac sarcoidosis after radiofrequency ablation and placement of AICD- a propensity matched analysis. Sarcoidosis Vasc Diffus Lung Dis. 2015;32(1):70–9.

    Google Scholar 

  16. Aizer A, Stern EH, Gomes JA, Teirstein AS, Eckart RE, Mehta D. Usefulness of programmed ventricular stimulation in predicting future arrhythmic events in patients with cardiac sarcoidosis. Am J Cardiol. 2005;96(2):276–82.

    Article  Google Scholar 

  17. Kron J, Sauer W, Schuller J, Bogun F, Crawford T, Sarsam S, et al. Efficacy and safety of implantable cardiac defibrillators for treatment of ventricular arrhythmias in patients with cardiac sarcoidosis. Europace. 2013;15(3):347–54.

    Article  Google Scholar 

  18. Mehta D, Mori N, Goldbarg SH, Lubitz S, Wisnivesky JP, Teirstein A. Primary prevention of sudden cardiac death in silent cardiac sarcoidosis role of programmed ventricular stimulation. Circ Arrhythmia Electrophysiol. 2011;4(1):43–8.

    Article  Google Scholar 

  19. Watanabe H, Chinushi M, Izumi D, Sato A, Okada S, Okamura K, et al. Decrease in amplitude of intracardiac ventricular electrogram and inappropriate therapy in patients with an implantable cardioverter defibrillator. Int Heart J. 2006;47:363–70.

    Article  Google Scholar 

  20. Nakano M, Kondo Y, Nakano M, Miyazawa K, Hayashi T KY. Prognosis of cardiac sarcoidosis in patients with implantable cardioverter defibrillator-primary versus secondary prevention. In: Sudden cardiac death and implantable defibrillator [internet]. EP Europace, volume 19, issue suppl_3, 1 June 2017, pages iii301; 2017. p. Pages iii301. Available from: https://doi.org/10.1093/ehjci/eux158.105.

  21. Higgins JPT GS. Cochrane handbookfor systematic reviews of interventions version 5.1.0 [Internet]. The Cochrane Collaboration. 2011. Available from: www.handbook.cochran.org

  22. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ Br Med J. 2003;327(7414):557–60.

    Article  Google Scholar 

  23. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa Hosp Res Inst. 2013;3:1–4.

    Google Scholar 

  24. Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw [Internet]. 2010;36(3). Available from: https://www.jstatsoft.org/v036/i03

  25. Vaseghi M, Hu TY, Tung R, Vergara P, Frankel DS, Di Biase L, et al. Outcomes of catheter ablation of ventricular tachycardia based on etiology in nonischemic heart disease. JACC Clin Electrophysiol. 2018;4(9):1141–50.

    Article  Google Scholar 

  26. Køber L, Thune JJ, Nielsen JC, Haarbo J, Videbæk L, Korup E, et al. Defibrillator implantation in patients with nonischemic systolic heart failure. N Engl J Med. 2016;375(13):1221–30.

    Article  Google Scholar 

  27. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Amiodarone or an implantable cardioverter–defibrillator for congestive heart failure. N Engl J Med. 2005;352(3):225–37.

    Article  CAS  Google Scholar 

  28. Greulich S, Deluigi CC, Gloekler S, Wahl A, Zürn C, Kramer U, et al. CMR imaging predicts death and other adverse events in suspected cardiac sarcoidosis. JACC Cardiovasc Imaging. 2013;6(4):501–11.

    Article  Google Scholar 

  29. Lin G, Dispenzieri A, Brady PA. Successful termination of a ventricular arrhythmia by implantable cardioverter defibrillator therapy in a patient with cardiac amyloidosis: insight into mechanisms of sudden death. Eur Heart J. 2010;31(12):1538.

    Article  Google Scholar 

  30. Yodogawa K, Seino Y, Ohara T, Takayama H, Katoh T, Mizuno K. Effect of corticosteroid therapy on ventricular arrhythmias in patients with cardiac Sarcoidosis. Ann Noninvasive Electrocardiol. 2011;16(2):140–7.

    Article  Google Scholar 

  31. Sohail MR, Uslan DZ, Khan AH, Friedman PA, Hayes DL, Wilson WR, et al. Risk factor analysis of permanent pacemaker infection. Clin Infect Dis. 2007;45(2):166–73.

    Article  Google Scholar 

  32. Kandolin R, Lehtonen J, Airaksinen J, Vihinen T. Cardiac sarcoidosis: epidemiology, characteristics, and outcome over 25 years in a nationwide study. Circulation. 2015;17(131):624–32.

    Article  Google Scholar 

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Authors and Affiliations

  1. Clinical Cardiac Electrophysiology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Ahmad Halawa

  2. Indiana University School of Medicine, Indianapolis, IN, USA

    Rahul Jain

  3. Helmsley Center for Cardiac Electrophysiology, Mount Sinai Hospital, New York, USA

    Mohit K. Turagam

  4. Division of Cardiovascular Medicine, Mayo Clinic Hospital, Jacksonville, FL, USA

    Fred M. Kusumoto

  5. Biostatistics Research Design Unit, University of Missouri-Columbia, Columbia, MO, USA

    Henok G. Woldu

  6. Division of Cardiovascular Medicine, University of Missouri-Columbia, Columbia, MO, USA

    Sandeep Gautam

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  1. Ahmad Halawa
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Correspondence to Ahmad Halawa.

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Halawa, A., Jain, R., Turagam, M.K. et al. Outcome of implantable cardioverter defibrillator in cardiac sarcoidosis: a systematic review and meta-analysis. J Interv Card Electrophysiol 58, 233–242 (2020). https://doi.org/10.1007/s10840-020-00705-1

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