Possibility of steroid therapy without pacemaker implantation in patients with sarcoidosis presenting atrioventricular block: letter to the editor (response to Yalta K et al.)

We are very honored that Yalta K, et al. are interested in our manuscript.

We agree on their opinion that the patients with recovery of atrioventricular (AV) conduction potentially need to be evaluated with electrophysiological study.

We previously investigated 15 sarcoidosis patients presenting with advanced or complete AV block. All patients were treated with prednisone after device implantation. After steroid therapy, AV block resolved to normal conduction or first-degree AV block in 7 patients. The improvement was driven within the first week after initiation of steroid therapy in 4 patients, while 3 patients showed late recovery of AV conduction. Seven patients underwent electrophysiological study, and intra-cardiac electrogram showed atrio-hisian block in 2 patients in the recovery patients, while infra-hisian block was detected in 3 patients in the non-recovery patients (1). Therefore, electrophysiological study might be useful to predict response to steroid therapy.

In the present study, our 2 recovery patients had uneventful clinical course over 5 and 2 years (2). However, AV block may recur under steroid therapy. A large, prospective, long-term follow-up study is needed for further validation.