PDF(Pubmed)
Abstract：
UNASSIGNED: Cardiac sarcoidosis is associated with heart failure, conduction abnormalities, and life-threatening arrhythmias including ventricular tachycardia (VT). Radiotherapy has been suggested as a treatment for extra-cardiac sarcoidosis in patients refractory to immunomodulatory treatment.
UNASSIGNED: The effectiveness and safety of low-dose whole-heart radiotherapy for therapy refractory cardiac sarcoidosis were evaluated in a pre- and post-intervention case report comparing the 54 months before and after treatment. Immunomodulatory low-dose whole-heart irradiation as sarcoidosis treatment consisted of a 2 × 2 Gy scheme. Additionally, high-dose single-fraction stereotactic arrhythmia radioablation of 1 × 20 Gy was applied to the pro-arrhythmic region to manage the ventricular tachycardia episodes. Cardiac sarcoidosis disease activity was measured by hypermetabolic areas on repeated fluorodeoxyglucose ([18F]FDG)-PET/computed tomography (CT) scans and by evaluating changes in ventricular tachycardia episodes before and after treatment.
UNASSIGNED: One patient with therapy refractory progressive cardiac sarcoidosis and recurrent ventricular tachycardia was treated. The cardiac sarcoidosis disease activity showed a durable regression of inflammatory disease activity from 3 months onwards. The [18F]FDG-PET/CT scan at 54 months did not show any signs of active cardiac sarcoidosis, and a state of remission was achieved. The number of sustained VT episodes was reduced by 95%. We observed that the development of moderate aortic valve regurgitation was likely irradiation-related. No other irradiation-related adverse events occurred, and the left ventricular ejection fraction remained stable.
UNASSIGNED: We report here for the first time on the beneficial and lasting effects of combined immunomodulatory low-dose whole-heart radiotherapy and high-dose stereotactic arrhythmia radioablation in a patient with therapy refractory cardiac sarcoidosis and recurrent VT.
UNASSIGNED: The effectiveness and safety of low-dose whole-heart radiotherapy for therapy refractory cardiac sarcoidosis were evaluated in a pre- and post-intervention case report comparing the 54 months before and after treatment. Immunomodulatory low-dose whole-heart irradiation as sarcoidosis treatment consisted of a 2 × 2 Gy scheme. Additionally, high-dose single-fraction stereotactic arrhythmia radioablation of 1 × 20 Gy was applied to the pro-arrhythmic region to manage the ventricular tachycardia episodes. Cardiac sarcoidosis disease activity was measured by hypermetabolic areas on repeated fluorodeoxyglucose ([18F]FDG)-PET/computed tomography (CT) scans and by evaluating changes in ventricular tachycardia episodes before and after treatment.
UNASSIGNED: One patient with therapy refractory progressive cardiac sarcoidosis and recurrent ventricular tachycardia was treated. The cardiac sarcoidosis disease activity showed a durable regression of inflammatory disease activity from 3 months onwards. The [18F]FDG-PET/CT scan at 54 months did not show any signs of active cardiac sarcoidosis, and a state of remission was achieved. The number of sustained VT episodes was reduced by 95%. We observed that the development of moderate aortic valve regurgitation was likely irradiation-related. No other irradiation-related adverse events occurred, and the left ventricular ejection fraction remained stable.
UNASSIGNED: We report here for the first time on the beneficial and lasting effects of combined immunomodulatory low-dose whole-heart radiotherapy and high-dose stereotactic arrhythmia radioablation in a patient with therapy refractory cardiac sarcoidosis and recurrent VT.
摘要：
■心脏结节病与心力衰竭有关，传导异常,和危及生命的心律失常，包括室性心动过速（VT）。已建议将放射疗法作为对免疫调节治疗无效的患者的心脏外结节病的治疗方法。
■在干预前后54个月的病例报告中评估了低剂量全心放疗治疗难治性心脏结节病的有效性和安全性。作为结节病治疗的免疫调节低剂量全心照射包括2×2Gy方案。此外,在致心律失常区域应用1×20Gy的大剂量单部分立体定向心律失常放射消融术治疗室性心动过速.通过重复的氟脱氧葡萄糖（[18F]FDG）-PET/计算机断层扫描（CT）扫描的高代谢区域以及评估治疗前后室性心动过速发作的变化来测量心脏结节病疾病的活动性。
■治疗1例难治性进行性心脏结节病和复发性室性心动过速。从3个月起，心脏结节病疾病活动显示出炎症性疾病活动的持久消退。54个月时的[18F]FDG-PET/CT扫描未显示任何活动性心脏结节病的迹象，达到了缓解的状态。持续的VT发作次数减少了95%。我们观察到中度主动脉瓣反流的发展可能与辐射有关。无其他辐射相关不良事件发生，左心室射血分数保持稳定。
■我们在此首次报道了免疫调节性低剂量全心放射治疗和高剂量立体定向心律失常放射消融术对难治性心脏结节病和复发性室性心动过速患者的有益和持久的影响。
■在干预前后54个月的病例报告中评估了低剂量全心放疗治疗难治性心脏结节病的有效性和安全性。作为结节病治疗的免疫调节低剂量全心照射包括2×2Gy方案。此外,在致心律失常区域应用1×20Gy的大剂量单部分立体定向心律失常放射消融术治疗室性心动过速.通过重复的氟脱氧葡萄糖（[18F]FDG）-PET/计算机断层扫描（CT）扫描的高代谢区域以及评估治疗前后室性心动过速发作的变化来测量心脏结节病疾病的活动性。
■治疗1例难治性进行性心脏结节病和复发性室性心动过速。从3个月起，心脏结节病疾病活动显示出炎症性疾病活动的持久消退。54个月时的[18F]FDG-PET/CT扫描未显示任何活动性心脏结节病的迹象，达到了缓解的状态。持续的VT发作次数减少了95%。我们观察到中度主动脉瓣反流的发展可能与辐射有关。无其他辐射相关不良事件发生，左心室射血分数保持稳定。
■我们在此首次报道了免疫调节性低剂量全心放射治疗和高剂量立体定向心律失常放射消融术对难治性心脏结节病和复发性室性心动过速患者的有益和持久的影响。
