Atrial Arrhythmias in Clinically Manifest Cardiac Sarcoidosis: Incidence, Burden, Predictors, and Outcomes

Abstract

Background Recent data have suggested a substantial incidence of atrial arrhythmias (AAs) in cardiac sarcoidosis (CS). Our study aims were to first assess how often AAs are the presenting feature of previously undiagnosed CS. Second, we used prospective follow‐up data from implanted devices to investigate AA incidence, burden, predictors, and response to immunosuppression. Methods and Results This project is a substudy of the CHASM‐CS (Cardiac Sarcoidosis Multicenter Prospective Cohort Study; NCT01477359). Inclusion criteria were presentation with clinically manifest cardiac sarcoidosis, treatment‐naive status, and implanted with a device that reported accurate AA burden. Data were collected at each device interrogation visit for all patients and all potential episodes of AA were adjudicated. For each intervisit period, the total AA burden was obtained. A total of 33 patients met the inclusion criteria (aged 56.1±7.7 years, 45.5% women). Only 1 patient had important AAs as a part of the initial CS presentation. During a median follow‐up of 49.1 months, 11 of 33 patients (33.3%) had device‐detected AAs, and only 2 (6.1%) had a clinically significant AA burden. Both patients had reduced burden after CS was successfully treated and there was no residual fluorodeoxyglucose uptake on positron emission tomography scan. Conclusions First, we found that AAs are a rare presenting feature of clinically manifest cardiac sarcoidosis. Second, AAs occurred in a minority of patients at follow‐up; the burden was very low in most patients. Only 2 patients had clinically significant AA burden, and both had a reduction after CS was treated. Registration URL: https://www.clini​caltr​ials.gov ; unique identifier NCT01477359.

Risk and predictors of heart failure in sarcoidosis in a population-based cohort study from Sweden

“…However, no association was observed between hypertension and HF likely due to the inclusion of other predictors of cardiovascular disease. Risks of diabetes and atrial fibrillation peak immediately after sarcoidosis diagnosis 4 21 22 and although it is disputed whether the latter is a manifestation of cardiac sarcoidosis, 11 12 their presence might lead to diagnosis of HF. A large proportion of future HF cases (>35%) could therefore be attributed to factors unrelated to sarcoid heart involvement.…”

“… 6 Cardiac sarcoidosis overtly or covertly affects 5%–30% of patients and commonly manifests with ventricular arrhythmias (12-fold increased risk associated with sarcoidosis, 7 conduction anomalies, sudden cardiac arrest or death, 6 8–10 and rarely as atrial fibrillation). 11 12 Data on the relative contribution of traditional and sarcoidosis-specific risk factors to HF are scarce. 6 Because the underlying mechanisms leading to HF in sarcoidosis may vary greatly, it is critical to examine the factors that contribute the most to HF occurrence, which could aid early identification of at-risk patients who might be targeted with the appropriate preventive, diagnostic or therapeutic measures.…”

Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association

“…Atrial fibrillation had a reported prevalence of 32% in 1 single-center study of individuals with CS. 103,104 Atrial fibrillation is more common in individuals with CS who have atrial tracer uptake on FDG-PET scan 105 or myocardial LGE on CMR (although none of these atrial findings are specific to sarcoidosis). Limited data suggest that immunosuppression may reduce the burden of atrial arrhythmias.…”

“…Limited data suggest that immunosuppression may reduce the burden of atrial arrhythmias. 104 Anticoagulation and arrhythmia management are the same for individuals without CS, and atrial fibrillation ablation appears to be of similar efficacy in individuals with and those without CS. 106 Ventricular Arrhythmia Ventricular tachycardia and fibrillation are among the most feared complications of CS and may be the primary presentation.…”

“…Limited data suggest that immunosuppression may reduce the burden of atrial arrhythmias. 104 Anticoagulation and arrhythmia management are the same for individuals without CS, and atrial fibrillation ablation appears to be of similar efficacy in individuals with and those without CS. 106…”