Key result
Corticosteroid therapy alone successfully managed transient high-grade atrioventricular block in a patient with newly diagnosed cardiac sarcoidosis without device implantation over one year.
Why the study?
Atrioventricular blocks in cardiac sarcoidosis are challenging to manage, with ambiguity regarding which patient cohorts actually benefit from device therapy.
Does corticosteroid therapy without device implantation prevent cardiovascular events in patients with newly diagnosed cardiac sarcoidosis and transient atrioventricular block?
Case Report (n=1)
No
Does corticosteroid therapy without device implantation prevent cardiovascular events in patients with newly diagnosed cardiac sarcoidosis and transient atrioventricular block?
Corticosteroid therapy alone may be a feasible management strategy for selected patients with newly diagnosed cardiac sarcoidosis presenting with transient high-grade AV block, potentially avoiding the need for device implantation.
May avoid unnecessary device implantation in select CS-AVB cases; leaves open criteria for immunosuppression-first strategy.
Atrioventricular blocks (AVBs) presenting in cardiac sarcoidosis (CS) remain an ongoing challenge for clinicians. While most initiate immunosuppressive therapy with the goal of pursuing device implantation, there is some ambiguity as to which patient cohorts actually benefit from device therapy. We present a case of a 39-year-old African American male with a past medical history of hypertension and no prior cardiac history who presented with substernal chest pain in the setting of a hypertensive emergency. He was later diagnosed with cardiac sarcoidosis by cardiac magnetic resonance imaging. His hospital course was complicated by transient Mobitz II atrioventricular block. He was started on prednisone, and while initially scheduled for an implantable cardioverter-defibrillator (ICD), his conduction block recovered. Through a multidisciplinary approach, the patient was discharged on medical management with outpatient follow-up. Since his initial hospitalization, the patient has not had any concerning cardiovascular events over the past year and has not been treated with device therapy. Our case illustrates the feasibility of effectively managing patients with cardiac sarcoidosis presenting with transient atrioventricular blocks only with corticosteroid therapy without needing device implantation.
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Rathore et al. (2023) conducted a case report in Cardiac sarcoidosis with transient high-grade atrioventricular block (n=1). Corticosteroid therapy (Prednisone) was evaluated on Recovery of AV block and absence of cardiovascular events. Corticosteroid therapy alone successfully managed transient high-grade atrioventricular block in a patient with newly diagnosed cardiac sarcoidosis without device implantation over one year.
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