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

doi:10.1515/med-2022-0611

Open Medicine (Dec 2022)

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

DOI: https://doi.org/10.1515/med-2022-0611
Journal volume & issue: Vol. 17, no. 1
pp. 2109 – 2116

Abstract

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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.

Published in Open Medicine

ISSN: 2391-5463 (Online)
Publisher: De Gruyter
Country of publisher: Poland
LCC subjects: Medicine
Website: https://www.degruyter.com/journal/key/med/html

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