ICD Shocks in Cardiac Sarcoidosis. Background: An implantable cardioverter defibrillator (ICD)is indicated for some patients with cardiac sarcoidosis (CS) for prevention of sudden death. However, there are little data regarding the event rates of ICD therapies in these patients. We sought to identify the incidence and characteristics of ICD therapies in this patient population.Methods: We performed a cohort study of patients with ICDs at 3 institutions. Cases were those patients with CS and an ICD implanted for primary or secondary prevention of sudden death. Additionally, we included a comparison with historical controls of ICD therapy rates reported in clinical trials evaluating the ICD for primary and secondary prevention of sudden death.Results ]).Conclusions: In our cohort of patients with CS and ICDs, almost one-third receive appropriate therapies. This may be due to a myocardial inflammatory process leading to increased triggered activity and subsequent scarring leading to reentrant tachyarrhythmias. Adjusted predictors of ICD therapies in this population include left or right ventricular dysfunction. (J Cardiovasc Electrophysiol, Vol. 23, pp. 925-929, September 2012) cardiac sarcoid, cardiomyopathy, heart failure, implantable cardioverter defibrillator, ventricular tachycardia

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Randomized, controlled trials have demonstrated that chronic therapy with macrolide antibiotics reduces the morbidity of patients with cystic fibrosis, non-cystic fibrosis bronchiectasis, chronic obstructive pulmonary disease, and nontuberculous mycobacterial infections. Lower levels of evidence indicate that chronic macrolides are also effective in treating patients with panbronchiolitis, bronchiolitis obliterans, and rejection after lung transplant. Macrolides are known to cause torsade des pointes and other ventricular arrhythmias, and a recent observational study prompted the FDA to strengthen the Warnings and Precautions section of azithromycin drug labels. This summary describes the electrophysiological effects of macrolides, reviews literature indicating that the large majority of subjects experiencing cardiac arrhythmias from macrolides have coexisting risk factors and that the incidence of arrhythmias in absence of coexisting risk factors is very low, examines recently published studies describing the relative risk of arrhythmias from macrolides, and concludes that this risk has been overestimated and suggests an approach to patient evaluation that should reduce the relative risk and the incidence of arrhythmias to the point that chronic macrolides can be used safely in the majority of subjects for whom they are recommended.

A multicenter registry for the purpose of research collaboration of this rare disease was established, with the University of Michigan serving as the coordinating center for this study. This registry was © 2014 American Heart Association, Inc. Original Article Circ Arrhythm ElectrophysiolBackground-The purpose of this study was to assess whether delayed enhancement (DE) on MRI is associated with ventricular tachycardia (VT)/ventricular fibrillation or death in patients with cardiac sarcoidosis and left ventricular ejection fraction >35%. Methods and Results-Fifty-one patients with cardiac sarcoidosis and left ventricular ejection fraction >35% underwent DE-MRI. DE was assessed by visual scoring and quantified with the full-width at half-maximum method. The patients were followed for 48.0±20.2 months. Twenty-two of 51 patients (63%) had DE. Forty patients had no prior history of VT (primary prevention cohort). Among those, 3 patients developed VT and 2 patients died. DE was associated with risk of VT/ventricular fibrillation or death (P=0.0032 for any DE and P<0.0001 for right ventricular DE). The positive predictive values of the presence of any DE, multifocal DE, and right ventricular DE for death or VT/ventricular fibrillation at mean follow-up of 48 months were 22%, 48%, and 100%, respectively. Among the 11 patients with a history of VT before the MRI, 10 patients had subsequent VTs, 1 of whom died. approved by all institutional review boards with data use agreements in place. Using previously published criteria, 5,6 patients who met diagnostic criteria for CS were identified. Patients from the University of Michigan, Henry Ford Hospital, University of Colorado, Johns Hopkins University, and Virginia Commonwealth University were included. Medical records were reviewed to identify patients who had cardiac MRIs, a left ventricular (LV) ejection fraction >35%, and ≥6 months of follow-up. Stored electrograms documenting arrhythmia episodes were reviewed to confirm appropriateness of ICD therapies (antitachycardia pacing or ICD discharge). Electrocardiograms and stored electrograms were analyzed, and ventricular arrhythmias were classified as monomorphic ventricular tachycardia (VT), polymorphic VT, or ventricular fibrillation (VF). Ventricular arrhythmia in the non-ICD group was defined as cardiac arrest, VT lasting ≥30 seconds or requiring defibrillation. VT/VF storm was defined as ≥3 episodes of VT/VF in a 24-hour period. Conclusions-RV DE in patients with cardiac sarcoidosis is associated with a risk of adverse events in patients with Cardiac MRIAll patients underwent cardiac MRI, including cine imaging of cardiac morphology and function and DE-MRI. All studies were performed on 1.5 Tesla scanners (Signa Excite CV/i; General Electric; Milwaukee, Wisconsin; Magnetom Sonata; Siemens Medical Solutions; Erlangen, Germany, Philips Healthcare, Best, The Netherlands). Cine imaging was performed in ventricular short-and long-axis planes using a segmented 2D steady-statefree-precession pulse sequence (repetition time,...

Patients with CS and ICDs are at high risk for ventricular arrhythmias. This population also has high rates of inappropriate shocks and device complications.

By decreasing ionic concentration and charge density in RFA using HNS instead of NS irrigant, larger ablation lesions can be created and are similar in size to lesions created using bipolar ablation. This may be a useful ablation strategy for deep myocardial circuits refractory to standard ablation. Further studies are needed to evaluate this novel RFA strategy.

The presence of fQRS or BBB pattern in patients with pulmonary sarcoidosis is associated with cardiac involvement and therefore should prompt further evaluation.

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