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Dual Medical Therapy for Treatment of Ventricular Arrhythmias in Cardiac Sarcoidosis
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  • Robert Sibilia,
  • Robert Baughman,
  • Daniel Washko,
  • Elyse Lower,
  • Alexandru Costea
Robert Sibilia
University of Cincinnati Academic Health Center

Corresponding Author:[email protected]

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Robert Baughman
University of Cincinnati Academic Health Center
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Daniel Washko
University of Cincinnati Academic Health Center
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Elyse Lower
University of Cincinnati Academic Health Center
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Alexandru Costea
University of Cincinnati
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Abstract

Background Immunosuppression and antiarrhythmics can be useful for the treatment of arrhythmias in cardiac sarcoidosis (CS) according to current guidelines. However, there is conflicting evidence on the optimal regimen and outcomes of medical therapy for ventricular arrhythmias. The effects of corticosteroid sparing agents with versus without concurrent antiarrhythmic therapy is unknown. Objective To assess the impact of corticosteroid sparing immunosuppression with and without antiarrhythmics on arrhythmia burdens in CS. Methods Patients with CS and implanted cardiac devices were identified from a single center registry. Their medical regimens were grouped as no therapy, immunosuppression alone, antiarrhythmic alone, or dual therapy. Device interrogations were reviewed for premature ventricular contractions (PVCs), nonsustained ventricular tachycardia (NSVT), and appropriate device firing. Results Interrogations for 42 patients were reviewed over a mean of 31 months. Regression analysis showed a significant decrease in the PVC (slope -1.47, p=0.04) and NSVT frequency (slope -0.05, p=.01) for patients on dual therapy compared to an increase or no change in the other groups. Across all patients, there was no difference between groups in the percentage of patients experiencing device firing. In a subset analysis of patients with ICDs for primary prevention, 6% on dual therapy required device firing compared to 43% and 40% on single or no therapy (P=.049, Chi Sq=6.02). Conclusions Patients on both immunosuppression and antiarrhythmics had a reduction in PVCs and NSVT over time. Those with devices placed for primary prevention experienced fewer device firings while on dual therapy.