Outcomes of patients with definite and suspected isolated cardiac sarcoidosis treated with an implantable cardiac defibrillator

Kron, Jordana; Sauer, William H.; Mueller, Gisela C.; Schuller, Joseph L.; Bogun, Frank; Sarsam, Sinan; Rosenfeld, Lynda E.; Mitiku, Teferi; Cooper, Joshua M.; Mehta, Davendra; Greenspon, Arnold J.; Ortman, Matthew; Delurgio, David B.; Valadri, Ravinder; Narasimhan, Calambur; Swapna, Nalla; Singh, Jagmeet P.; Danik, Stephan B.; Markowitz, Steven M.; Almquist, Adrian K.; Krahn, Andrew D.; Wolfe, Luke; Feinstein, Shawn; Ellenbogen, Kenneth A.; Crawford, Thomas

doi:10.1007/s10840-015-9978-3

Cited by 29 publications

(36 citation statements)

References 18 publications

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“…240,241 In a retrospective study, patients with isolated cardiac sarcoidosis had very high rates of appropriate ICD therapy. 242 Whether patients with cardiac sarcoidosis without functional cardiac myocardial impairment and without spontaneous significant arrhythmias should be considered for ICD therapy or at least some risk-stratification strategy is more controversial. 231 Cardiac transplantation has been used with success in patients with cardiac sarcoidosis.…”

Section: Treatmentmentioning

confidence: 99%

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Bozkurt¹,

Colvin²,

Cook³

et al. 2016

Circulation

602

663

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CLINICAL STATEMENTS AND GUIDELINEST he intent of this American Heart Association (AHA) scientific statement is to summarize our current understanding of dilated cardiomyopathies. There is special emphasis on recent developments in diagnostic approaches and therapies for specific cardiomyopathies. Recommendations in this document are based on published studies, published practice guidelines from the American College of Cardiology (ACC)/AHA 1 and other organizations, 2,3 and the multidisciplinary expertise of the writing group. Existing evidence in epidemiology, classification, diagnosis, and management of specific cardiomyopathies is usually derived from nonrandomized observational studies, registries, case reports, or expert opinion based on clinical experience, not large-scale randomized clinical trials or systematic reviews. Therefore, in this document, rather than using the standard ACC/AHA classification schema of recommendations and level of evidence, 4 we have included key management strategies at the end of each section and categorized our recommendations according to the level of consensus. Although the format of our recommendations might resemble the ACC/AHA classification of recommendations used in the ACC/AHA practice guidelines, because of the preponderance of expert opinion or level of evidence C evidence in our document, we elected to use different terminology to provide a distinction from the practice guidelines, in which stronger levels and quality of evidence with randomized clinical trials or meta-analyses are usually present. 4 The levels of evidence follow the AHA and ACC methods of classifying the level of certainty of the treatment effect. 4 DEfINITIoN of DILATED CArDIoMyopAThyThe term dilated cardiomyopathy (DCM) refers to a spectrum of heterogeneous myocardial disorders that are characterized by ventricular dilation and depressed myocardial performance in the absence of hypertension, valvular, congenital, or ischemic heart disease. 5 In clinical practice, the pathogenesis of heart failure (HF) has often been placed into 2 categories: ischemic and nonischemic cardiomyopathy. The term nonischemic cardiomyopathy has been interchangeably used with DCM. Although this approach might be practical, it fails to recognize that nonischemic cardiomyopathy can include cardiomyopathies caused by volume or pressure overload (such as hypertension or valvular heart disease) that are not conventionally accepted under the definition of DCM. 1,5 Again, in general practice and clinical research trials, the term ischemic cardiomyopathy is defined as cardiomyopathy caused by ischemic heart disease. Current use of ischemic cardiomyopathy terminology implies ventricular dilation and depressed myocardial contractility caused by ischemia or infarction. CLASSIfICATIoN of CArDIoMyopAThIESThe first classification on this topic categorized cardiomyopathies as heart muscle diseases with dilated (DCM), hypertrophic, restrictive, arrhythmogenic right ventricular (ARVC), or nonclassifiable cardiomyopathy in 1980. 5 Subse...

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Section: Treatmentmentioning

confidence: 99%

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Bozkurt¹,

Colvin²,

Cook³

et al. 2016

Circulation

602

663

View full text Add to dashboard Cite

show abstract

“…Patients with systemic sarcoidosis and CS who are treated with prednisone may experience improvements in LV systolic function, especially those with mild to moderate dysfunction (e.g., LV ejection fraction of 30–55%). 33,34 While changes in LV systolic function in patients with ICS receiving immunosuppressive therapy have not been separately reported, it would be reasonable to expect a similar benefit in such individuals.…”

Section: Introductionmentioning

confidence: 99%

Isolated cardiac sarcoidosis: A focused review of an under-recognized entity

Okada

Bravo

Vita

et al. 2018

Journal of Nuclear Cardiology

132

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There is accumulating evidence for the existence of a phenotype of isolated cardiac sarcoidosis (ICS), or sarcoidosis that only involves the heart. In the absence of biopsy-confirmed cardiac sarcoidosis (CS), existing diagnostic criteria require the presence of extra-cardiac sarcoidosis as an inclusion criterion for the diagnosis of CS. Consequently, in the absence of a positive endomyocardial biopsy, ICS is not diagnosable by current guidelines. Therefore, there is uncertainty regarding the epidemiology, pathobiology, clinical characteristics, prognosis, and optimal treatment of ICS. This review will summarize the available data related to the prevalence and prognosis of ICS and will discuss challenges surrounding the diagnosis and management of this under-recognized entity.

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“…However, considered retrospectively, the ventricular tachycardia and complete atrioventricular block might have appeared as a series of symptoms caused by cardiac sarcoidosis. When a treatment plan is determined, implantation of a dual chamber pacemaker/defibrillator should be considered to treat recurrence of ventricular tachycardia [7, 8]. However, the possibility of depression, anxiety, or other emotional impact that could result from ICD implantation should also be considered [9], especially because our patient had a history of panic attacks and anxiety disorder.…”

Section: Discussionmentioning

confidence: 99%

Cardiac sarcoidosis resembling panic disorder: a case report

et al. 2017

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BackgroundSarcoidosis is a systemic disease of unknown etiology, in which granulomas develop in various organs, including the skin, lungs, eyes, or heart. It has been reported that patients with sarcoidosis are more likely to develop panic disorder than members of the general population. However, there are many unknown factors concerning the causal relationship between these conditions.Case presentationWe present the case of a 57-year-old woman who appeared to have panic disorder, as she experienced repeated panic attacks induced by transient complete atrioventricular block, associated with cardiac sarcoidosis. Psychotherapy and pharmacotherapy were not effective in the treatment of her panic attacks. However, when we implanted a permanent pacemaker and initiated steroid treatment for cardiac sarcoidosis, panic attacks were ameliorated. Based on these findings, we diagnosed the patient’s symptoms as an anxiety disorder associated with cardiac sarcoidosis, rather than panic disorder.ConclusionsThis report highlights the importance of considering cardiac sarcoidosis in the differential diagnosis of panic disorder. This cardiac disease should be considered especially in patients have a history of cardiac disease (e.g., arrhythmia) and atypical presentations of panic symptoms. Panic disorder is a psychiatric condition that is typically diagnosed after other medical conditions have been excluded. Because the diagnosis of sarcoidosis is difficult in some patients, caution is required. The palpitations and symptoms of heart failure associated with cardiac sarcoidosis can be misdiagnosed as psychiatric symptoms of panic disorder. The condition described in the current case study appears to constitute a physical disease, the diagnosis of which requires significant consideration and caution.

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Outcomes of patients with definite and suspected isolated cardiac sarcoidosis treated with an implantable cardiac defibrillator

Cited by 29 publications

References 18 publications

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Isolated cardiac sarcoidosis: A focused review of an under-recognized entity

Cardiac sarcoidosis resembling panic disorder: a case report

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