心サルコイドーシスによる完全房室ブロックにプレドニソロンを投与した3例

Prednisolone Therapy in the Three Cases with Complete Atrio-ventricular Block Caused by Cardiac Sarcoidosis

　心サルコイドーシスによる完全房室プロツク（以下CAVB）3例にプレドニソロン（以下PSL）を投与したが，投与後の経過が異なった．症例1は48歳，女性．CAVB発生75日後にPSL 50mgを開始したが，投与18日後にCAVBは消失した．症例2は63歳，女性．CAVB発生75日後にPSL 50mgを開始したが，投与51日後にCAVBは消失した．10mgで維持していた10ヵ月後に心室性期外収縮が頻発するようになり，心室細動を引き起こした．PSLの増量は無効であった．症例3は51歳，女性．CAVB発生34ヵ月後にPSL 50mgを開始したが，無効であった．また，高度の心機能低下が認められた．CAVB発生後，より早期にPSLを投与したほうがCAVBには有効である．しかし，投与後，新たに重篤な不整脈が出現することがあるため厳重な経過観察を要する．

Three patients who had complete atrio-ventricular block (CAVB) caused by cardiac sarcoidosis were treat-ed with prednisolone (PSL) therapy, but there were differences in their progress. Case 1, a 48-year-old woman : the PSL therapy of 50mg was begun 75 days after the first occurrece of CAVB. The CAVB disappeared 18 days later. Case 2, a 63-year-old woman the PSL therapy of 50mg was begun 75 days after the first occurrence of CAVB. The CAVB disappeared 51 days later. Ten months after the maintenance therapy of 10mg PSL, premature ventricular contractions occurred often and ventricular fibrillation began. The patient was treated again with PSL therapy of bigger doses, but it had no effect. Case 3, a 51-year-old woman : the ther-apy was begun 34 months after the first occurrence of CAVB. But this treatment had no effect. Severe cardiac dysfunction began.

The earlier the therapy after CAVB, the better effect it has. Careful observation is advised because some new and severe arrhythmia may sometimes occur.