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Rosenthal DG, Fang CD, Groh CA, Nah G, Vittinghoff E, Dewland TA, Vedantham V, Marcus GM. Heart Failure, Atrioventricular Block, and Ventricular Tachycardia in Sarcoidosis. J Am Heart Assoc 2021; 10:e017692. [PMID: 33599141 PMCID: PMC8174291 DOI: 10.1161/jaha.120.017692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Sarcoidosis is a granulomatous disease usually affecting the lungs, although cardiac morbidity may be common. The risk of these outcomes and the characteristics that predict them remain largely unknown. This study investigates the epidemiology of heart failure, atrioventricular block, and ventricular tachycardia among patients with and without sarcoidosis. Methods and Results We identified California residents aged ≥21 years using the Office of Statewide Health Planning and Development ambulatory surgery, emergency, or inpatient databases from 2005 to 2015. The risk of sarcoidosis on incident heart failure, atrioventricular block, and ventricular tachycardia were each determined. Linkage to the Social Security Death Index was used to ascertain overall mortality. Among 22 527 964 California residents, 19 762 patients with sarcoidosis (0.09%) were identified. Sarcoidosis was the strongest predictor of heart failure (hazard ratio [HR], 11.2; 95% CI, 10.7-11.7), atrioventricular block (HR, 117.7; 95% CI, 103.3-134.0), and ventricular tachycardia (HR, 26.1; 95% CI, 24.2-28.1) identified among all risk factors. The presence of any cardiac involvement best predicted each outcome. Approximately 22% (95% CI, 18%-26%) of the relationship between sarcoidosis and increased mortality was explained by the presence of at least 1 of these cardiovascular outcomes. Conclusions The magnitude of risk associated with sarcoidosis as a predictor of heart failure, atrioventricular block, and ventricular tachycardia, exceeds all established risk factors. Surveillance for and anticipation of these outcomes among patients with sarcoidosis is indicated, and consideration of a sarcoidosis diagnosis may be prudent among patients with heart failure, atrioventricular block, or ventricular tachycardia.
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Affiliation(s)
- David G Rosenthal
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Christina D Fang
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Christopher A Groh
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Gregory Nah
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics University of California, San Francisco CA
| | - Thomas A Dewland
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Vasanth Vedantham
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Gregory M Marcus
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
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Terasaki F, Azuma A, Anzai T, Ishizaka N, Ishida Y, Isobe M, Inomata T, Ishibashi-Ueda H, Eishi Y, Kitakaze M, Kusano K, Sakata Y, Shijubo N, Tsuchida A, Tsutsui H, Nakajima T, Nakatani S, Horii T, Yazaki Y, Yamaguchi E, Yamaguchi T, Ide T, Okamura H, Kato Y, Goya M, Sakakibara M, Soejima K, Nagai T, Nakamura H, Noda T, Hasegawa T, Morita H, Ohe T, Kihara Y, Saito Y, Sugiyama Y, Morimoto SI, Yamashina A. JCS 2016 Guideline on Diagnosis and Treatment of Cardiac Sarcoidosis - Digest Version. Circ J 2019; 83:2329-2388. [PMID: 31597819 DOI: 10.1253/circj.cj-19-0508] [Citation(s) in RCA: 196] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Fumio Terasaki
- Medical Education Center / Department of Cardiology, Osaka Medical College
| | - Arata Azuma
- Department of Pulmonary Medicine, Nippon Medical School
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Nobukazu Ishizaka
- Department of Internal Medicine (III) / Department of Cardiology, Osaka Medical College
| | - Yoshio Ishida
- Department of Internal Medicine, Kaizuka City Hospital
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University
| | - Takayuki Inomata
- Department of Cardiology, Kitasato University Kitasato Institute Hospital
| | | | - Yoshinobu Eishi
- Department of Human Pathology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Takatomo Nakajima
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center
| | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | - Taiko Horii
- Department of Cardiovascular Surgery, Kagawa University School of Medicine
| | | | - Etsuro Yamaguchi
- Department of Respiratory Medicine and Allergology, Aichi Medical University School of Medicine
| | | | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Hideo Okamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiology, Tokyo Medical and Dental University
| | - Mamoru Sakakibara
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University Faculty of Medicine
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takuya Hasegawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Tohru Ohe
- Department of Cardiology, Sakakibara Heart Institute of Okayama
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Yoshihiko Saito
- Department of Cardiorenal Medicine and Metabolic Disease, Nara Medical University
| | - Yukihiko Sugiyama
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University
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3
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Bravo PE, Raghu G, Rosenthal DG, Elman S, Petek BJ, Soine LA, Maki JH, Branch KR, Masri SC, Patton KK, Caldwell JH, Krieger EV. Risk assessment of patients with clinical manifestations of cardiac sarcoidosis with positron emission tomography and magnetic resonance imaging. Int J Cardiol 2017; 241:457-462. [PMID: 28318664 DOI: 10.1016/j.ijcard.2017.03.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/17/2017] [Accepted: 03/07/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Prior studies have shown that late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) and fluorodeoxyglucose (FDG) positron emission tomography (PET) confer incremental risk assessment in patients with cardiac sarcoidosis (CS). However, the incremental prognostic value of the combined use of LGE and FDG compared to either test alone has not been investigated, and this is the aim of the present study. METHODS Retrospective observational study of 56 symptomatic patients with high clinical suspicion for CS who underwent LGE-CMR and FDG-PET and were followed for the occurrence of death and/or malignant ventricular arrhythmias (VA). RESULTS The combination of PET and CMR yielded the following groups: 1) LGE-negative/normal-PET (n=20), 2) LGE-positive/abnormal-FDG (n=20), and 3) LGE-positive/normal FDG (n=16). After a median follow-up of 2.6years (IQR 1.2-4.1), 16 patients had events (7 deaths, 10 VA). All, but 1, events occurred in patients with LGE. LGE-positive/abnormal-FDG (7 events, HR 10.1 [95% CI 1.2-84]; P=0.03) and LGE-positive/normal-FDG (8 events, HR 13.3 [1.7-107]; P=0.015) patients had comparable risk of events compared to the reference LGE-negative/normal-PET group. In adjusted Cox-regression analysis, presence of LGE (HR 18.1 [1.8-178]; P=0.013) was the only independent predictor of events. CONCLUSION CS patients with LGE alone or in association with FDG were at similar risk of future events, which suggests that outcomes may be driven by the presence of LGE (myocardial fibrosis) and not FDG (inflammation).
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Affiliation(s)
- Paco E Bravo
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA, United States; Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
| | - Ganesh Raghu
- Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - David G Rosenthal
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Shana Elman
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Bradley J Petek
- University of Washington School of Medicine, Seattle, WA, United States
| | - Laurie A Soine
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA, United States; Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Jeffrey H Maki
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Kelley R Branch
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Sofia C Masri
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Kristen K Patton
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA, United States
| | - James H Caldwell
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA, United States; Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Eric V Krieger
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA, United States
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Rosenthal DG, Bravo PE, Patton KK, Goldberger ZD. Management of Arrhythmias in Cardiac Sarcoidosis. Clin Cardiol 2015; 38:635-40. [PMID: 26175285 DOI: 10.1002/clc.22430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/04/2015] [Accepted: 05/08/2015] [Indexed: 12/15/2022] Open
Abstract
The prevalence of cardiac involvement in sarcoidosis is under-recognized and is associated with multiple complications, including conduction block, arrhythmias, and sudden death. The comparative roles of common therapies have been inadequately studied. The purpose of this review is to examine the literature regarding treatments utilized to manage arrhythmias associated with cardiac sarcoidosis.
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Affiliation(s)
- David G Rosenthal
- Department of Internal Medicine, University of Washington Medical Center, Seattle, Washington
| | - Paco E Bravo
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington
| | - Kristen K Patton
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington
| | - Zachary D Goldberger
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington
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Panda S, Kaur D, Lalukota K, Sundar G, Pavri BB, Narasimhan C. Pleomorphism during Ventricular Tachycardia: A Distinguishing Feature between Cardiac Sarcoidosis and Idiopathic VT. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:694-9. [PMID: 25754130 DOI: 10.1111/pace.12626] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 02/23/2015] [Accepted: 03/01/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ventricular tachycardia (VT), a common manifestation of cardiac sarcoidosis (CS), is associated with high morbidity and mortality. It could be mistaken for idiopathic VT (IVT) in the absence of systemic manifestations and overt cardiac structural abnormality. We studied the electrocardiogram (ECG) characteristics of VT in CS that may distinguish from IVT and also explored the relationship of the ECG characteristics with imaging findings in patients with CS. METHODS AND RESULTS Twelve-lead ECG characteristics of VT in CS patients (Group I = 37) were compared with IVT (Group II = 49). QRS duration, axis, morphology, VT cycle length, and cycle length variation (CLV) were analyzed. In Group I, 18 (49%) had pleomorphic VT (PLVT) and none in Group II. CLV was seen only in Group I (24%). Mean QRS duration (milliseconds) and cycle length (milliseconds) were greater in Group I (QRSd 152.49 [39.3] vs 140.9 [19.2]) and (332.2 [136.5] vs 312.9 [56.2]), the differences not statistically significant. In Group I, myocardial scar was present in 22 of 25 patients and myocardial inflammation in 28 of 29 patients as assessed by cardiac magnetic resonance imaging (delayed enhancement) and 18-fluorodeoxyglucose positron emission computed tomography, respectively. PLVT was seen more commonly in patients with involvement of >1 myocardial region than focal involvement (58% and 30%, respectively, with myocardial scar and 50% and 40%, respectively, with myocardial inflammation). CONCLUSION Pleomorphism and CLV during VT may be distinguishing features between IVT and VTs of CS origin.
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Affiliation(s)
| | - Daljeet Kaur
- CARE Hospital, Division of Cardiac Electrophysiology, Hyderabad, India
| | | | - Gomathi Sundar
- CARE Hospital, Division of Cardiac Electrophysiology, Hyderabad, India
| | - Behzad B Pavri
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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6
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Golwala H, Dernaika T. Atrial fibrillation as the initial clinical manifestation of cardiac sarcoidosis. J Cardiovasc Med (Hagerstown) 2015; 16 Suppl 2:S104-12. [DOI: 10.2459/jcm.0b013e328343b589] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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8
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LATCU DECEBALGABRIEL, DUPARC ALEXANDRE, CHABBERT VALERIE, LABARRE DAVID, MONDOLY PIERRE, MAURY PHILIPPE, DELAY MARC. Systemic Sarcoidosis Revealed by Ventricular Tachycardia: Electrocardiography and MRI Correspondence. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:1566-70. [DOI: 10.1111/j.1540-8159.2007.00909.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Banba K, Kusano KF, Nakamura K, Morita H, Ogawa A, Ohtsuka F, Ogo KO, Nishii N, Watanabe A, Nagase S, Sakuragi S, Ohe T. Relationship between arrhythmogenesis and disease activity in cardiac sarcoidosis. Heart Rhythm 2007; 4:1292-9. [PMID: 17905334 DOI: 10.1016/j.hrthm.2007.06.006] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Accepted: 06/10/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND In patients with cardiac sarcoidosis, ventricular arrhythmias and/or conduction disturbances are frequently observed and sometimes fatal. However, few reports on disease activity and arrhythmic events in cardiac sarcoidosis are available. OBJECTIVE The purpose of this study was to investigate the relationship between disease activity and arrhythmic events in cardiac sarcoidosis and the effect of corticosteroid therapy. METHODS The study population consisted of 15 cardiac sarcoidosis patients with new-onset symptomatic arrhythmia, including eight patients admitted once for complete atrioventricular block (CAVB), five patients admitted once for sustained ventricular tachycardia (VT), and two patients admitted twice for two arrhythmic events (one for CAVB and the other for sustained VT). Disease activity was evaluated by gallium-67 citrate (Ga) scintigraphy. All patients with positive Ga uptake were treated with corticosteroids, and arrhythmic events were evaluated by repeat Holter recordings. RESULTS Positive uptake of Ga was observed in 8 (80%) of the 10 CAVB events and in 1 (14%) of the 7 sustained VT events (80% vs 14%, P = .02). Corticosteroids abolished myocardial Ga uptake in all nine patients with positive Ga uptake. After corticosteroid therapy was started, AV conduction improved in 5 of 9 CAVB patients (including 8 patients with new-onset CAVB and one patient with history of CAVB). However, ventricular arrhythmias were not improved after corticosteroid therapy. CONCLUSION In cardiac sarcoidosis patients, CAVB develops mainly during the active phase of the disease. Early treatment with corticosteroids might improve AV conduction disturbance. However, sustained VT is not closely linked with disease activity and frequently develops in the advanced stage of disease.
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Affiliation(s)
- Kimikazu Banba
- Department of Cardiovascular Medicine, Graduate School of Medicine and Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
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Abstract
Sarcoidosis is an idiopathic granulomatous disease that may affect any organ. The varied manifestations of the disease may prompt patients with sarcoidosis to seek care from primary care physicians and subspecialists. This article outlines the approach to the evaluation and treatment of sarcoidosis by primary care physicians.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, USA.
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Miyaji K, Suzuki M, Mizukami A, Iwatsuka R, Kumasaka R, Ichihara N, Nagahori W, Oono M, Arakawa T, Masaki N, Matsumura A, Hashimoto Y. Suppression of Ventricular Tachycardia Associated with Cardiac Sarcoidosis by Steroid Therapy. J Arrhythm 2007. [DOI: 10.1016/s1880-4276(07)80036-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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Bargout R, Kelly RF. Sarcoid heart disease: clinical course and treatment. Int J Cardiol 2004; 97:173-82. [PMID: 15458680 DOI: 10.1016/j.ijcard.2003.07.024] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2003] [Revised: 06/28/2003] [Accepted: 07/25/2003] [Indexed: 11/19/2022]
Abstract
Sarcoidosis is a rare granulomatous disease of unknown etiology that can affect any organ. Cardiac involvement, although uncommon, has a wide spectrum of clinical manifestations and is potentially fatal. Although there is no agreement upon a strategy for the diagnosis (which is difficult to make based on clinical information alone), the introduction of newer technology is promising and may be useful both for the early diagnosis of cardiac involvement and for the evaluation of response to therapy. Early treatment is crucial in improving symptoms and prognosis. ICD implantation and cardiac transplantation may offer improvements in management, as steroid therapy and pacemaker implantation has led to improved outcomes over the past three decades.
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Affiliation(s)
- Raed Bargout
- Division of Adult Cardiology, Cook County Hospital, Chicago, IL 60612, USA
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Furushima H, Chinushi M, Sugiura H, Kasai H, Washizuka T, Aizawa Y. Ventricular tachyarrhythmia associated with cardiac sarcoidosis: its mechanisms and outcome. Clin Cardiol 2004; 27:217-22. [PMID: 15119697 PMCID: PMC6654157 DOI: 10.1002/clc.4960270409] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Cardiac sarcoidosis is increasingly recognized and is associated with poor prognosis. Ventricular tachycardia (VT) associated with cardiac sarcoidosis is the most likely cause of sudden death in most patients, but the mechanism has not been well established. HYPOTHESIS This study investigated the mechanisms and outcome of VT associated with cardiac sarcoidosis. METHODS The study included eight consecutive patients (five men, three women, aged 54 +/- 19 years) who had sustained monomorphic VT associated with cardiac sarcoidosis in our hospital. RESULTS The average ejection fraction was 43 +/- 11%. Twenty-two VTs were observed in these patients, and mean heart rate during VT was 192 +/- 29 beats/min (range 144-259). The phenomenon of transient entrainment was documented in 10 of 22 (45%) VTs by ventricular pacing (eight in the active phase). Another five (23%) VTs could not be entrained, but could be initiated by programmed stimulation and terminated by rapid pacing, reproducibly. In 3 of the 22 (14%) VTs, cardioversion was required urgently because of the fast rate, while the remaining 4 (18%) could be induced during electrophysiologic study. CONCLUSIONS In this study, there was a high possibility that the mechanism of 15 (68%) VTs was reentry. Reentrant substrate is formed not only in association with the healing of cardiac granulomas in the inactive phase of cardiac sarcoidosis but also in the active phase. Ventricular tachycardia with cardiac sarcoidosis, even if this mechanism is reentry, has different inducibility between the active and inactive phases in an electrophysiologic study. This makes the therapy for cardiac sarcoidosis (e.g., corticosteroids, antiarrhythmic agents, and catheter ablation) difficult. The implantable cardioverter-defibrillator is an effective treatment for ventricular tachyarrythmia with cardiac sarcoidosis.
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Affiliation(s)
- Hiroshi Furushima
- The First Department of Internal Medicine, Niigata University School of Medicine, Niigata, Japan.
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Abstract
The treatment of patients with sarcoidosis remains an important part of management. The role of corticosteroids has been questioned by some, while others have reported its value even in asymptomatic patients with interstitial lung disease. Cytotoxic agents have become standard therapy for some forms of chronic disease. Newer agents that modulate the immune response have been studied. A key cytokine in chronic sarcoidosis appears to be tumor necrosis factor. Drugs that inhibit its release or block its effect have been reported as effective for sarcoidosis.
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Affiliation(s)
- Robert P Baughman
- University of Cincinnati Medical Center, Interstitial Lung Disease and Sarcoidosis Clinic, Cincinnati, Ohio 45267-0565, USA.
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