Early temporary pacing after CMR improves prognosis in cardiac sarcoidosis patients with AV block: JAHA

Finland: In patients presenting with bradycardic atrioventricular block (AVB) requiring urgent pacing, CMR imaging with temporary permanent pacemaker protocol is a safe and effective early screening tool for myocardial disease, finds a new study. The study was published in the Journal of the American Heart Association. 

Further, the research revealed that an active fixation pacing lead connected to an extracorporeal pacing generator located on the neck may be a temporary treatment for AVB patients requiring urgent pacing for bradycardia. 

Some myocardial diseases, such as cardiac sarcoidosis, predispose to complete atrioventricular block. Myocardial disease screening is recommended in patients with conduction disorder requiring pacemaker with multimodality imaging, including cardiac magnetic resonance (CMR) imaging, according to the European Society of Cardiology Guidelines on cardiac pacing in 2021. However, the ability of CMR imaging for myocardial disease detection in patients with a temporary pacing wire is not thoroughly studied. 

Consodering the above, Aino‐Maija Vuorinen, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, and colleagues herein report clinical protocol for CMR‐based testing for myocardial disease in the setting of bradycardic AVB requiring urgent temporary pacing for severe bradycardia. They also evaluated the safety and IQ of CMR in this setting.

Myocardial disease screening protocol was based on the use of a active fixation pacing lead connected to a reusable extracorporeal pacing generator (temporary permanent pacemaker) as a bridge to a permanent pacemaker. From a CMR database, the researchers identified 17 patients from 2011 to 2019 who underwent CMR imaging with a temporary permanent pacemaker for atrioventricular block. Analysis of their CMR data, clinical presentations, and pacemaker therapy was done. 

Salient findings of the study include:

All CMRs were performed without adverse events.
Pacing leads induced minor artifacts to the septal myocardial segments. The extent of late gadolinium enhancement in CMR
imaging was used to screen patients for the presence of myocardial disease. Patients with evidence of late gadolinium
enhancement underwent endomyocardial biopsy. If considered clinically indicated, also 18‐F‐fluorodeoxyglucose
positron emission tomography and extracardiac tissue biopsy were performed if
sarcoidosis was suspected. 8 of 17 patients (47.1%) were diagnosed with
histologically confirmed granulomatous inflammatory cardiac disease. Only 1 had a previously diagnosed extracardiac
sarcoidosis at the time of presentation with high‐degree atrioventricular block.

The authors wrote in their study, “CMR imaging with temporary permanent pacemaker protocol is a safe and effective early screening tool for myocardial disease in patients presenting with AV block requiring immediate, continuous pacing for bradycardia.”

Reference:

Vuorinen AM, Lehtonen J, Pakarinen S, Holmström M, Kivistö S, Kaasalainen T. Cardiac Magnetic Resonance Imaging-Based Screening for Cardiac Sarcoidosis in Patients With Atrioventricular Block Requiring Temporary Pacing. J Am Heart Assoc. 2022 Jun 6:e024257. doi: 10.1161/JAHA.121.024257. Epub ahead of print. PMID: 35658507.

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