Pacemakers and methylprednisolone pulse therapy in immune-related myocarditis concomitant with complete heart block
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 patie...
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| Format: | Article |
| Language: | English |
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De Gruyter
2022-12-01
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| Series: | Open Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1515/med-2022-0611 |
| _version_ | 1797947724374474752 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Hu Chunhong |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-10T21:32:18Z |
| format | Article |
| id | doaj.art-073330cc956c4b22b875097b35707be4 |
| institution | Directory Open Access Journal |
| issn | 2391-5463 |
| language | English |
| last_indexed | 2024-04-10T21:32:18Z |
| publishDate | 2022-12-01 |
| publisher | De Gruyter |
| record_format | Article |
| series | Open Medicine |
| spelling | doaj.art-073330cc956c4b22b875097b35707be42023-01-19T13:04:57ZengDe GruyterOpen Medicine2391-54632022-12-011712109211610.1515/med-2022-0611Pacemakers and methylprednisolone pulse therapy in immune-related myocarditis concomitant with complete heart blockHu Chunhong0Zhao Lishu1Zhou Chengzhi2Wang Hanping3Jiang Shun4Li Yizheng5Peng Yurong6Deng Chao7Ma Fang8Pan Yue9Shu Long10Huang Yan11Zeng Yue12Wu Fang13Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, ChinaState 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, ChinaDepartment of Respiratory Medicine, Peking Union Medical College Hospital, Beijing, ChinaDepartment of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, ChinaImmune-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.https://doi.org/10.1515/med-2022-0611immune checkpoint inhibitormyocarditiscomplete heart blockpacemakermethylprednisolone pulse therapy |
| spellingShingle | 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 Pacemakers and methylprednisolone pulse therapy in immune-related myocarditis concomitant with complete heart block Open Medicine immune checkpoint inhibitor myocarditis complete heart block pacemaker methylprednisolone pulse therapy |
| title | Pacemakers and methylprednisolone pulse therapy in immune-related myocarditis concomitant with complete heart block |
| title_full | Pacemakers and methylprednisolone pulse therapy in immune-related myocarditis concomitant with complete heart block |
| title_fullStr | Pacemakers and methylprednisolone pulse therapy in immune-related myocarditis concomitant with complete heart block |
| title_full_unstemmed | Pacemakers and methylprednisolone pulse therapy in immune-related myocarditis concomitant with complete heart block |
| title_short | Pacemakers and methylprednisolone pulse therapy in immune-related myocarditis concomitant with complete heart block |
| title_sort | pacemakers and methylprednisolone pulse therapy in immune related myocarditis concomitant with complete heart block |
| topic | immune checkpoint inhibitor myocarditis complete heart block pacemaker methylprednisolone pulse therapy |
| url | https://doi.org/10.1515/med-2022-0611 |
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