Electrophysiologic manifestations of cardiac sarcoidosis

Abstract

The electrophysiologist's approach to a patient with cardiac sarcoidosis can aid in diagnosis, risk stratification, and management with antiarrhythmic therapy, catheter ablation, and ICD implantation for the prevention of SCD.

Biomarkers in electrophysiology: role in arrhythmias and resynchronization therapy

“…Conduction system abnormalities in cardiac sarcoidosis can result from direct involvement of the conduction system or ventricular wall from granulomatous infiltration and scar tissue [67]. The prevalence of SCD in cardiac sarcoidosis is reported between 12 and 65 % [68] and primary prevention via ICD implantation is a grade IIA recommendation (level C) [69]. Similarly CCC is associated with chronic inflammation resulting from Trypanosoma cruzi infection.…”

Management of Arrhythmias in Cardiac Sarcoidosis

“…Villes‐Gonzalez et al reported that 32% of CS patients developed a supraventricular arrhythmia during a mean 5.8‐year follow‐up, and 23% of these arrhythmias were due to either atrial fibrillation or flutter . These findings are corroborated by other studies . The lifetime risk of developing atrial fibrillation or flutter in the general population has been estimated at 26% in men and 23% in women, similar to the prevalence in the CS population …”

“…Sarcoidosis often affects the cardiac conduction system and causes a variety of clinical presentations ranging from normal electrocardiograms to complete atrioventricular (AV) block . Granuloma formation in the basal interventricular septum is thought to be the major mechanism of conduction disorders, with the location and burden of disease of the AV nodal arterial supply, the AV node itself, and/or the His‐Purkinje system determining the degree of dysfunction …”

“…A recent study has suggested that elevated ventricular diastolic pressures and remodeling of the tricuspid annulus caused by pulmonary hypertension is a significant risk factor for atrial flutter in CS patients . Zipse et al demonstrated that non–atrial fibrillation atrial arrhythmias are caused by triggered activity in 11% of cases, abnormal automaticity in 47% of cases, and reentry in 42% of cases …”

“…6 Granuloma formation in the basal interventricular septum is thought to be the major mechanism of conduction disorders, with the location and burden of disease of the AV nodal arterial supply, the AV node itself, and/or the His-Purkinje system determining the degree of dysfunction. 7…”