The Significance of Advanced Heart Block in Patients with Cardiac Sarcoidosis

Background: Advanced heart block (AHB) is one of major phenotypes in patients with cardiac sarcoidosis (CS), but their prognosis remains to be elucidated.Methods: We examined 68 consecutive patients with CS in Tohoku university hospital from October 1998 until September 2014 (56611 years-old, M/F 18/50, mean follow-up 5.5-year). CS was diagnosed according to the original guidelines for diagnosis of CS from the Japanese Ministry of Health and Welfare. All of the patients received corticosteroid therapy. Results: Twenty nine out of 68 (43%) patients had AHB at admission (AHB group). The AHB group had a tendency of higher BNP level as compared with no-AHB (358692.4 vs 200635.1pg/ml, p50.086), while there was no difference in left ventricular ejection fraction between groups (50.0618.9 vs 51.0614.6%, p50.801). Kaplan-Meier estimates of freedom from heart failure hospitalization after the introduction of corticosteroid therapy showed that AHB group had more events than no-AHB group did (P50.032). Furthermore, in 20 AHB patients excluding patients with CRT therapy before corticosteroid therapy, 14 AHB patients with non-reversible conduction disturbance had more events compared with 6 patients with reversible one (P50.013). Conclusions: The appearance of AHB could be a sign of poor prognosis in CS patients.