Early Corticosteroid Therapy and Its Effect on Ventricular Tachyarrhythmia Recurrence in Cardiac Sarcoidosis: A 10-Year Longitudinal Multicenter Study

Abstract

Introduction

The role of corticosteroids in the management of ventricular tachyarrhythmia (VA) in cardiac sarcoidosis (CS) remains controversial. This study assessed the effect of early steroid initiation on VA recurrence rates in patients with CS and evaluated VA frequency before and after steroid therapy.

Methods

From a registry of 137 patients with CS with arrhythmias, those with VA and more than 60 days of follow-up were included. Patients were categorized into three groups: previous-on-steroid, those using corticosteroids at the time of the first VA (n = 15); early-steroid, those with steroid initiation within 60 days (n = 21); and no-or-delayed-steroid, those without steroid use at 60 days from the first VA (n = 35). The VA recurrence and timing were analyzed.

Results

The median age at the first VA was 60 years. Over a median follow-up period of 81 (range: 4–345) months, 43 patients experienced VA recurrence. The median time to recurrence was 101, 33, and 17 months in the early-steroid, no-or-delayed steroid, and previous-on-steroid groups, respectively. Corticosteroid use at 60 days was an independent predictor of VA recurrence at 120 months (hazard ratio: 2.257; p = 0.045 in the no-or-delayed steroid group and hazard ratio: 3.155; p = 0.021 in the previous-on-steroid group vs. the early-steroid group). Low left ventricular ejection fraction (LVEF) was associated with frequent VA episodes. Corticosteroid initiation did not increase early VA episodes.

Conclusion

Early corticosteroid initiation after VA onset reduced the long-term recurrence without increasing early episodes. Cases of repetitive VA were common in those with low LVEF.