Pacemakers and methylprednisolone pulse therapy in immune-related myocarditis concomitant with complete heart block
Hu Chunhong,
Zhao Lishu,
Zhou Chengzhi,
Wang Hanping,
Jiang Shun,
Li Yizheng,
Peng Yurong,
Deng Chao,
Ma Fang,
Pan Yue,
Shu Long,
Huang Yan,
Zeng Yue,
Wu Fang
Affiliations
Hu Chunhong
Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
Zhao Lishu
Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
Zhou Chengzhi
State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
Wang Hanping
Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing, China
Jiang Shun
Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
Li Yizheng
Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
Peng Yurong
Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
Deng Chao
Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
Ma Fang
Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
Pan Yue
Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
Shu Long
Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
Huang Yan
Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
Zeng Yue
Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
Wu Fang
Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
Immune-related cardiotoxicities are uncommon but potentially fatal. The study aims to evaluate the value of pacemakers and methylprednisolone pulse therapy (MPPT) to patients with immune-related myocarditis concomitant with complete heart block (CHB). We first reviewed medical records of three patients with immune-related myocarditis concomitant with CHB. For the pooled analysis, we searched related cases with immune-related myocarditis in the PubMed database and screened the patients. Clinical characteristics, management, and outcomes were summarized. Our three patients developed immune-related myocarditis concomitant with CHB about 2 weeks after receiving pembrolizumab, and were successfully treated with pacemaker implantation and high-dose steroids (two received MPPT). In the pooled analysis, 21 cases were eligible with an overall fatality rate of 52%. Patients with pacemakers had a fatality rate of 38%, significantly lower than patients without them (38% vs 100%; p = 0.035), particularly the MPPT subgroup (25% vs 100%; p = 0.019). All five patients without pacemakers expired. Among patients with pacemakers, MPPT patients tended to have an inferior rate compared with non-MPPT patients. Timely pacemaker implantation played a crucial role in improving the outcomes of patients with immune-related myocarditis concomitant with CHB. Patients receiving MPPT appeared to have a better prognosis. Additionally, multidisciplinary consultation should be recommended for better management.
