Tailored approach for management of ventricular tachycardia in cardiac sarcoidosis

Yalagudri, Sachin; Thu, Ngwe Zin; Devidutta, Soumen; Saggu, Daljeet Kaur; Thachil, Ajit; Chennapragada, Sridevi; Narasimhan, Calambur

doi:10.1111/jce.13228

Cited by 50 publications

(45 citation statements)

References 21 publications

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“…Cardiac Sarcoidosis is characterized by myocardial inflammation and interstitial fibrosis which can lead to conduction slowing and macro‐reentrant arrhythmias 8,9,12,13,21–25 . Thus, substrate favorable for reentry is present in both the inflammatory and scar phase of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…During the initial phase of our study, we offered RFCA to all patients who were not controlled with disease‐specific therapy and with AADs irrespective of the stage of the disease, without intensifying the anti‐inflammatory medications. In the last 2 years, we consider ablation only after adequate immunosuppressive therapy 21 . Patients are first started on steroids along with AADs.…”

Section: Discussionmentioning

confidence: 99%

“…Patients are first started on steroids along with AADs. Over the next 8 weeks, steroids are replaced with a steroid‐sparing regimen including methotrexate with an overlap period of 4 weeks 21 . Ablation is reserved for incessant VT or VT storm unresponsive to immunosuppressants and AADs in the inflammatory phase of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…In the last 2 years, we consider ablation only after adequate immunosuppressive therapy. 21 Patients are first started on steroids along with AADs.…”

Section: Among Patients In Groupmentioning

confidence: 99%

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Impact of the inflammation on the outcomes of catheter ablation of drug‐refractory ventricular tachycardia in cardiac sarcoidosis

Kaur¹,

Roukoz

Shah³

et al. 2020

Cardiovasc electrophysiol

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Introduction Catheter ablation (CA) of ventricular tachycardia (VT) in cardiac sarcoidosis (CS) has been reported with varying success. However, there is a scarcity of data on the outcomes of CA based on ongoing inflammation. Objective We hypothesized that the response to VT ablation depends upon the stage of the disease. Methods Between July 2004 and December 2018, 24 patients of CS presented with drug‐refractory VT at CARE Hospital (Hyderabad) and the University of Minnesota (Minneapolis, MN). Patients were classified into two groups based on cardiac magnetic resonance imaging and positron emission tomography: (a) inflammatory phase, (b) scar phase. All patients underwent 3D electro‐anatomic mapping guided CA. Results The clinical VT was ablated in all but one patient. In 16 patients (66.6%), both the clinical and nonclinical VTs were ablated (complete success), while in seven patients (29.1%) nonclinical VTs was still inducible. In patients with inflammation (group A), complete success for VT ablation was achieved in 10 out of 17 (58.8%). In patients without inflammation (group B), complete success was achieved in six out of seven patients (85.7%). Eleven patients (45.8%) had a recurrence of VT. Among patients in the inflammatory phase (group A): 10 out of 17 patients had a recurrence of VT, while only one out of seven patients in the scar phase (group B) had VT recurrence over a mean follow‐up of 5.7 ± 3.9 years. Epicardial ablation was performed in 10 (41.6%) patients. Conclusion CA of drug‐refractory VT in CS is effective, often requiring the epicardial approach. Incomplete success and recurrence of VT were higher in the inflammatory phase of the disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…In the last 2 years, we consider ablation only after adequate immunosuppressive therapy. 21 Patients are first started on steroids along with AADs.…”

Section: Among Patients In Groupmentioning

confidence: 99%

See 2 more Smart Citations

Impact of the inflammation on the outcomes of catheter ablation of drug‐refractory ventricular tachycardia in cardiac sarcoidosis

Kaur¹,

Roukoz

Shah³

et al. 2020

Cardiovasc electrophysiol

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Bera

Pavri

Saggu

et al. 2020

Pacing Clinical Electrophis

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Background Implantable cardioverter defibrillator (ICD) is recommended for patients with ventricular tachycardia (VT) due to cardiac sarcoidosis (CS). Programming supraventricular tachycardia (SVT) discriminators (onset, stability, and morphology/template match) is generally recommended to minimize inappropriate therapies. However, VT in patients with CS is known to show cycle length variability (CLV) and pleomorphism. Objective To determine whether the stability criterion, designed to prevent inappropriate therapy during atrial fibrillation with rapid ventricular rates, could potentially lead to incorrect classification of VT as SVT and inappropriately delay or inhibit ICD therapy. Methods Cases of biopsy‐proven CS with VT were analyzed. For patients with implanted devices, all recorded electrograms of tachycardia episodes and ICD therapies were analyzed at last follow up. Results A total of 142 patients were included (mean age 38 years, 87 males). One hundred and three of 142 patients had implanted devices (ICD or CRT‐D). Thirty eight of 103 (36.9%) patients received appropriate ICD therapies over 3 ± 2.2 years follow up. Four of 38 (10.5%) of patients experienced delayed‐detection or underdetection of VT related to CLV, resulting in VT counters being repeatedly “reset” (classified as “unstable” rhythms). Retrospective analysis of other VT episodes in 70 of 103 (68%) patients revealed that 25 of 80 (31.3%) episodes had > 50 ms cycle length oscillations. Conclusion Among CS patients with VT, CLV is a common occurrence seen in two‐thirds of VT episodes. Routine programming of the stability criterion may result in underdetection of VT in a subset of such patients. We recommend that the stability criterion should be programmed “OFF” for patients with CS, unless the patient has documented atrial fibrillation.

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Kardiale Beteiligung bei Sarkoidose

Yilmaz,

Meier

2023

Springer Reference Medizin

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Tailored approach for management of ventricular tachycardia in cardiac sarcoidosis

Abstract: Tailoring therapy for VT in CS according to the phase of disease results in good clinical outcome and avoids unnecessary immunosuppression.

Cited by 50 publications

References 21 publications

Impact of the inflammation on the outcomes of catheter ablation of drug‐refractory ventricular tachycardia in cardiac sarcoidosis

Impact of the inflammation on the outcomes of catheter ablation of drug‐refractory ventricular tachycardia in cardiac sarcoidosis

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

Kardiale Beteiligung bei Sarkoidose

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