Cardiac Sarcoidosis, Left Ventricular Impairment and Chronic Right Ventricular Pacing: Pacing or Pathology?

Forotan, H.; Rowe, Matthew K.; Korczyk, Dariusz; Kaye, G.

doi:10.1016/j.hlc.2017.03.167

Cited by 6 publications

(9 citation statements)

References 36 publications

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“…Early recognition and treatment of underlying CS can prevent progressive LV dysfunction, reduce morbidity and mortality as well as prevent unnecessary device upgradation or cardiac transplantation. Some authors [5,11,12] have also reported similar cases, where underlying CS rather than PICM which was responsible for progressive LV dysfunction. It is indeed difficult to suspect CS among patients diagnosed of PICM as majority of do not have systemic involvement.…”

Section: Discussionmentioning

confidence: 89%

“…Varying degree of LV dysfunction or AV block can be the initial presentation of occult CS [3,4]. It is a progressive disease and what presented as AV block may be followed by LV systolic dysfunction due to chronic inflammatory myocarditis in due course [5]. Unrecognized, such patients usually have upgradation to cardiac resynchronisation therapy (CRT) and some eventually have cardiac transplantation.…”

Section: Introductionmentioning

confidence: 99%

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Severe left ventricular systolic dysfunction after permanent pacemaker implantation: Should we pause before upgrading to biventricular pacing?

Bera

Yalagudri

Devidutta

et al. 2019

Indian Pacing and Electrophysiology Journal

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Left ventricular (LV) systolic dysfunction leading to heart failure (HF) is known to occur after permanent pacemaker implantation (PPI) in a subset of patients. They are often treated by upgradation of the pacemaker to cardiac resynchronisation therapy (CRT). We report a case of progressive LV dysfunction and HF after PPI. Cardiac 18 FDG-PET-CT scan revealed abnormal myocardial FDG uptake suggestive of cardiac sarcoidosis (CS). Biopsy from FDG avid lymph node demonstrated non-caseating granuloma. Therapy with steroids resulted in resolution of HF symptoms accompanied by a significant improvement in LV function.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Severe left ventricular systolic dysfunction after permanent pacemaker implantation: Should we pause before upgrading to biventricular pacing?

Bera

Yalagudri

Devidutta

et al. 2019

Indian Pacing and Electrophysiology Journal

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“…Prior studies have shown that patients with non‐left bundle branch block (LBBB) QRS morphologies have less reduced remodeling than those with LBBB 33–35 . There is also an added complexity of determining pacing‐induced cardiomyopathy (PICM) with chronic right ventricular pacing in patients who received an upgrade 36 . Within our cohort we note a statistically significant reduction in QRS width post CRT implantation (166.6 ± 29.3 to 154.7 ± 23.1 ms).…”

Section: Discussionmentioning

confidence: 99%

Cardiac resynchronization therapy response in cardiac sarcoidosis

Shabtaie

Sehrawat

Lee

et al. 2022

Cardiovasc electrophysiol

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Introduction: Cardiac sarcoidosis (CS) is a nonischemic cardiomyopathy (NICM) characterized by infiltration of noncaseating granulomas involving the heart with highly variable clinical manifestations that can include conduction abnormalities and systolic heart failure. Cardiac resynchronization therapy (CRT) has shown significant promise in NICM, though little is known about its efficacy in patients with CS. Objective: To determine if CRT improved cardiac remodeling in patients with CS. Methods: We retrospectively reviewed all patients with a clinical or histological diagnosis of CS who underwent CRT implantation at the Mayo Clinic enterprise from 2000 to 2021. Baseline characteristics, imaging parameters, heart failure hospitalizations and need for advanced therapies, and major adverse cardiac events (MACE) were assessed.Results: Our cohort was comprised of 55 patients with 61.8% male and a mean age of 58.7 ± 10.9 years. Eighteen (32.7%) patients had definite CS, 21 (38.2%) had probable CS, while 16 (29.1%) had presumed CS, and 26 (47.3%) with extracardiac sarcoidosis. The majority underwent CRT-D implantation (n = 52, 94.5%) and 3(5.5%) underwent CRT-P implantation with 67.3% of implanted devices being upgrades from prior pacemakers or implantable cardioverter defibrillators. At 6 months postimplantation there was no significant improvement in ejection fraction (34.8 ± 10.9% vs. 37.7 ± 14.2%, p = .331) or left ventricular end-diastolic diameter (58.5 ± 10.2 vs. 57.5 ± 8.1 mm, p = .236), though mild improvement in left ventricular end systolic diameter (49.1 ± 9.9 vs. 45.7± 9.9 mm, p < .0001). Within the first 6 months postimplantation, 5 (9.1%) patients sustained a heart failure hospitalization.At a mean follow-up of 4.1± 3.7 years, 14 (25.5%) patients experienced a heart

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“… Pacing or pathology : another issue is that of underlying cardiac disease, perhaps not appreciated at the time the patient presents with a pacing indication, and where a reduction in LV function occurs some time, perhaps years, after device implant. Forotan et al describe two cases where, after many years of RV pacing, significant LV impairment became clinically apparent and subsequently cardiac sarcoidosis was diagnosed not apparent at the time of device implant . This emphasizes the difficulties and complexities of establishing the mechanisms which cause left ventricular deterioration in paced patients.…”

Section: Factors Not Related To Lead Positionmentioning

confidence: 99%

“…Forotan et al describe two cases where, after many years of RV pacing, significant LV impairment became clinically apparent and subsequently cardiac sarcoidosis was diagnosed not apparent at the time of device implant. 103 This emphasizes the difficulties and complexities of establishing the mechanisms which cause left ventricular deterioration in paced patients. It may be that at presentation more focus should be placed on potential underlying pathologies particularly in those patients presenting with high grade AV block.…”

Section: Factors Not Related To Lead Positionmentioning

confidence: 99%

The desire for physiological pacing: Are we there yet?

Kaye

2019

Cardiovasc electrophysiol

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Pacing is a well established therapy for bradycardia support and certain types of heart failure. Despite technological advances the optimal pacing lead position remains controversial. Right ventricular pacing, particularly apical has been the site of choice but the induction of abnormal cardiac depolarization and the recognition of an increased risk of impairment of left ventricular systolic function, heart failure and mortality has driven a desire for a true physiological pacing system. A number of different lead positions have been determined and of these His bundle pacing appears to most closely mimic normal ventricular conduction. This article reviews the background to the development of physiological pacing, evaluates historical data for right ventricular pacing and the basis for change and new lead positions.

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Cardiac Sarcoidosis, Left Ventricular Impairment and Chronic Right Ventricular Pacing: Pacing or Pathology?

Cited by 6 publications

References 36 publications

Severe left ventricular systolic dysfunction after permanent pacemaker implantation: Should we pause before upgrading to biventricular pacing?

Severe left ventricular systolic dysfunction after permanent pacemaker implantation: Should we pause before upgrading to biventricular pacing?

Cardiac resynchronization therapy response in cardiac sarcoidosis

The desire for physiological pacing: Are we there yet?

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