Pleomorphism during Ventricular Tachycardia: A Distinguishing Feature between Cardiac Sarcoidosis and Idiopathic VT

Abstract

Pleomorphism and CLV during VT may be distinguishing features between IVT and VTs of CS origin.

Underdiagnosis of VT due to cycle length variation among cardiac sarcoidosis patients having ICD: Problem with stability discriminator

“…The major findings of our study were: As we have previously reported, 3 it is not uncommon to see CLV in VT of patients with CS.The stability criterion, if used as an SVT discriminator, can delay detection in the VT zone (or fast VT zones in Medtronic devices when programmed “via VT”).…”

“…VT in CS can be due to re‐entry (from scar), but in the early stage is more often related to inflammation leading to VT resulting from automaticity and triggered activity 4,5 . VT thus can have CLV and pleomorphism, 3 especially during this inflammatory phase. In general, all ICDs discriminate VT from SVT based on the following three criteria 6,7 : Onset (sudden vs gradual–VT or SVT, vs sinus tachycardia, respectively);Stability (stable vs unstable–VT vs AF); andMorphology (matching to sinus template vs not matching–SVT vs VT)…”

“…All types of VT morphologies have been described in CS, ranging from nonsustained VT, sustained monomorphic VT, polymorphic VT, and ventricular fibrillation 2 . It is not uncommon to see pleomorphism and cycle length variability (CLV) 3 . There is a potential for such irregular VTs to be misdiagnosed as supraventricular tachycardia (SVT) by the stability criterion, resulting in delayed VT therapy.…”

Ten Questions Cardiologists Should Be Able to Answer About Cardiac Sarcoidosis: Case-Based Approach and Contemporary Review

“…26 Polymorphic VT and cycle length variation during VT might be more in favour of CS. 29 VT tends to occur in the fibrotic stage of CS and mainly results from reentry circuits through regions of scars. 26 Another suggested mechanism for VT is abnormal automaticity from granulomas.…”

Bedside to Bench – A Difficult Journey: An Irregular Wide QRS Tachycardia

“…However, reentrant arrhythmias are more likely to be monomorphic, but this is not exclusive. Recently, Panda, et.al., compared VT morphologies between CS and idiopathic VT and found that pleomorphism during VT was more common in CS than in idiopathic VT [9]. The group from UCLA has proposed a new entity, arrhythmogenic inflammatory cardiomyopathy in patients with occult sarcoidosis [10].…”