A case report of recovery of sinus node abnormalities associated with right atrial involvement of ‘early-stage’ cardiac sarcoidosis

Abstract

Background Cardiac sarcoidosis (CS) is a chronic inflammatory disease characterised by impaired contractility of the myocardium secondary to cardiac conduction system abnormalities, which result in atrio-ventricular (AV) conduction block and ventricular tachyarrhythmias. Notably, sinus node (SN) abnormalities are rarely associated with CS. Case Summary We herein present a case of CS presenting with SN abnormalities associated with atrial involvement of the CS and describe the utility of cardiac magnetic resonance imaging (cMRI), fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18-FDG RET-CT) scans, and cardiac biopsy, in making an initial early diagnosis of early-stage CS. Fortunately, an initial appropriate immunosuppression therapy with methylprednisolone for the CS thus far can help the SN and AV conduction function recover and has provided a good clinical course without the implantation of a pacemaker or implantable cardio-defibrillator. Discussion Although the diagnosis of CS may be elusive, the initial clinical suspicion and use of advanced imaging may be important for an early diagnosis of CS. Further, because CS may sometimes rapidly progress, the early diagnosis and treatment of early-stage CS may also be important to help the SN and AV conduction function recover, and avoid an implantation of a pacemaker, as in this present case.

Arrhythmias in Cardiac Sarcoidosis: Management and Prognostic Implications

“…Whether this is related to direct involvement of the atrial tissue around the sinus node or ischemia/infarction of the coronary blood supply is not definitive. Similarly, the exact incidence of sinus node dysfunction in these patients is not well known [ 42 , 43 , 44 ].…”