title: Recovery of atrioventricular block following steroid therapy in patients with cardiac sarcoidosis.
abstract: BACKGROUND
  Atrioventricular (AV) block is one of the main clinical manifestations in patients with cardiac sarcoidosis (CS). Although steroid therapy is considered to be effective for AV block, the efficacy has not been demonstrated in detail.
  
  
  RESULTS
  Fifteen CS patients presenting with advanced or complete AV block were retrospectively investigated. All patients were treated with 30mg/day of prednisone after device implantation, which was tapered to a maintenance dosage of 5-10mg/day. During a mean follow-up of 7.1 years, AV block resolved to normal conduction or first-degree AV block in 7 patients (recovery group). The improvement was driven within the first week of steroid therapy in 4 patients, while 3 patients showed late recovery of AV conduction. The remaining 8 patients were classified as the non-recovery group. The recovery group showed a higher left ventricular ejection fraction (69.4±8.9% versus 44.1±19.3%, p=0.029) and higher prevalence of advanced AV block (87.5% versus 28.6%, p=0.040) compared with those of the non-recovery group. In patients with the recovery group, there was no late recurrence of AV block during the follow-up period.
  
  
  CONCLUSIONS
  Early initiation of steroid therapy may be effective for AV block, and steroid therapy before device implantation is a possible therapeutic strategy for some selected patients.
authors.affiliation: Division of Cardiology, Geriatrics, and Integrated Medicine, Department of Internal Medicine, Nippon Medical School, Tokyo 113-8603, Japan. Electronic address: yodo@nms.ac.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yodogawa
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Seino
authors.forename: Reiko
authors.initials: R
authors.lastname: Shiomura
authors.forename: Kenta
authors.initials: K
authors.lastname: Takahashi
authors.forename: Ippei
authors.initials: I
authors.lastname: Tsuboi
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Uetake
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hayashi
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Horie
authors.forename: Yu-Ki
authors.initials: YK
authors.lastname: Iwasaki
authors.forename: Meiso
authors.initials: M
authors.lastname: Hayashi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miyauchi
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D054537:Atrioventricular Block / Q000188:drug therapy* / Q000209:etiology*; D058406:Cardiac Resynchronization Therapy; D009202:Cardiomyopathies / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011239:Prednisolone / Q000008:administration & dosage*; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D011239:Prednisolone
keywords: Atrioventricular block; Cardiac sarcoidosis; Corticosteroid