Aims Corticosteroids are widely used in patients with cardiac sarcoidosis (CS). In addition, upgrading to cardiac resynchronization therapy (CRT) is sometimes needed. This study aimed to investigate the impact of corticosteroid use on the clinical outcomes following CRT upgrades. Methods A total of 48 consecutive patients with non-ischemic cardiomyopathies who underwent CRT upgrades were retrospectively reviewed and divided into three groups: group 1 included CS patients taking corticosteroids before the CRT upgrade (n = 7), group 2, CS patients not taking corticosteroids before the CRT upgrade (n = 10), and group 3, non-CS patients (n = 31). The echocardiographic response, heart failure hospitalizations, and cardiovascular deaths were evaluated. Results The baseline characteristics during CRT upgrades exhibited no significant differences in the echocardiographic data between the three groups. After the CRT upgrade, responses regarding the ejection fraction (EF) and end-systolic volume (ESV) were significantly lower in CS patients than non-CS patients (ΔEF: group 1, 6.7% vs. group 2, 7.7% vs. group 3, 13.6%; p=0.039, ΔESV: 3.0 mL vs. -12.7 mL vs. -37.2 mL; p = 0.008). The rate of an echocardiographic response was lowest in group 1 (29%). There were, however, no significant differences in the cumulative freedom from a composite outcome among the three groups (p = 0.19). No cardiovascular deaths occurred in group 1. Conclusion CS patients taking corticosteroids before the CRT upgrade had lower echocardiographic responses but higher freedom rates from a composite endpoint. The timing of corticosteroid use would affect the clinical course following a CRT upgrade.

Introduction: It has been reported that ventricular tachycardia (VT) non-inducibility at the end of ablation is associated with less likely VT recurrence. However, it is not clear whether we should use VT non-inducibility as routine end point in VT ablation. The aim of this study was to evaluate VT recurrence in patients in whom VT non-inducibility could not be achieved at the end of the RF ablation and the factors attributing to the VT recurrence. METHODS and RESULTS: We analyzed 84 consecutive patients that underwent RF ablation, and 64 patients in whom VT non-inducibility could not be achieved were studied. The primary endpoint was recurrence of any sustained VT during the follow-up. During a median follow-up period of 1.4 years (IQR:0.3-2.0), 22 (34%) of the cases had VT recurrences. In the multivariate analysis showed that an LVEF≥35% (HR:0.21; 95% CI:0.07- 0.54; P<0.01) and successful identification and ablation of all clinical VT isthmuses (HR:0.21; 95% CI:0.03- 0.72; P=0.01) were independent predictors of fewer VT recurrences. RF ablation was associated with a 91.1% reduction in VT episodes. CONCLUSION: Even if VT non-inducibility could not be achieved, the patients with LVEF≥35% or in whom all clinical VT isthmuses could successfully be identify and ablated might be prevented from having VT recurrences. The validity of VT non-inducibility of any VT should be evaluated by each patient’s background and the results of the procedure.