Recovery of atrioventricular block following steroid therapy in patients with cardiac sarcoidosis

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. Methods and results: Fifteen CS patients presenting with advanced or complete AV block were retrospectively investigated. All patients were treated with 30 mg/day of prednisone after device implantation, which was tapered to a maintenance dosage of 5-10 mg/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. (C) 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.