Atrioventricular Block as the Initial Manifestation of Cardiac Sarcoidosis in Middle‐Aged Adults

Nery, Pablo B.; Beanlands, Rob; Nair, Girish M.; Green, Martin A.; Yang, Jim; McArdle, Brian; Davis, Darryl R.; Ohira, Hiroshi; Gollob, Michael H.; Leung, Eugene; Healey, Jeff S.; Birnie, David H.

doi:10.1111/jce.12401

Cited by 166 publications

(114 citation statements)

References 29 publications

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“…As genetic testing was not feasible in our patient, we screened his family members for conduction abnormalities, of which there were none. Other conditions such as infiltrative disorders (lymphoma, sarcoidosis) and infective conditions (chagas) can present in a similar manner, but were ruled out in this index case 10 11…”

Section: Discussionmentioning

confidence: 98%

Trifascicular block progressing to complete AV block on exercise: a rare presentation demonstrating the usefulness of exercise testing

et al. 2015

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SUMMARYA 41-year-old man presented with dyspnoea and giddiness on exertion for the last 1 month. A resting ECG during showed trifascicular block with complete right bundle branch block, left anterior fascicular block and a prolonged PR interval of >0.24 s. His echocardiography showed no evidence of wall motion abnormality. He was subjected to a treadmill test for exercise-induced ischaemia, which showed complete atrioventricular (AV) block during first stage of Bruce protocol. His symptoms of dyspnoea and giddiness were also reproduced. The test was terminated and ECG returned to trifascicular block, similar to that at his baseline ECG during recovery. Coronary angiogram (CAG) was performed to rule out any ischaemic cause for this exercise-induced AV block, which was normal. In view of his reproducible symptoms and demonstration of complete AV block on exercise, a dual-chamber pacemaker (DDD) was implanted. His symptoms disappeared and he remained asymptomatic on follow-up. BACKGROUND

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Section: Discussionmentioning

confidence: 98%

Trifascicular block progressing to complete AV block on exercise: a rare presentation demonstrating the usefulness of exercise testing

et al. 2015

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“…This group had higher adverse cardiac events compared with patients without sarcoidosis [6]. Advanced AV block in young patients should raise the suspicion of sarcoidosis if it is associated with CHF or arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Rapidly Progressive Atrioventricular Block in a Patient with Sarcoidosis

Jafar

Shamkhani

Narayanan

et al. 2014

Case Reports in Cardiology

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Cardiac sarcoidosis is a major cause of death in patients with systemic sarcoidosis. Cardiac manifestations are seen in 2.3% of the patients. Atrioventricular (AV) block is one of the common manifestations of cardiac sarcoidosis. Other presentations of cardiac involvement include congestive heart failure, ventricular arrhythmias, and sudden cardiac death. The presence of AV block in young patients should raise the suspicion of sarcoidosis. AV block may be the only manifestation and patients may not have clinical evidence of pulmonary involvement. Here we describe a young male presented with exercise induced AV block rapidly progressing to complete heart block with recurrent syncope needing urgent pacemaker implantation. Factors that suggested an infiltrative process included his young age, rapidly progressive conduction abnormalities in the ECG in the absence of coronary disease, and previous history of cutaneous sarcoidosis.

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“…These include new onset unexplained advanced heart block in adults under 60 years of age and/or unexplained ventricular tachycardia. Among patients with new unexplained heart block, cardiac sarcoidosis may be present in 25-34 % [10,11]. Furthermore, numerous reports have described unexplained sustained monomorphic ventricular tachycardia (VT) as the initial presenting symptom of cardiac sarcoidosis.…”

Section: When Is Advanced Multimodality Imaging Needed In a Patient Wmentioning

confidence: 99%

Multimodality Imaging of Cardiac Sarcoidosis

Blankstein

Miller

2015

Cardiac Sarcoidosis

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In addition to aiding the diagnosis, the role of imaging for patients with known or suspected cardiac sarcoidosis includes estimating the risk of future adverse events (prognosis) as well as identifying individuals who are more likely to benefit from immunosuppressive therapies. When considering these goals, cardiac MRI and PET both visualize different attributes of cardiac sarcoidosis and often have a complementary role. While the absence of late gadolinium enhancement on cardiac MRI has a high negative predictive value for excluding cardiac involvement and identifying patients with an excellent prognosis, PET is better suited for detecting and quantifying the amount of active myocardial inflammation. Data comparing these techniques is limited; however, we recommend that unless contraindications exist, cardiac MRI should be the preferred imaging test for screening patients who have abnormalities that are concerning for cardiac sarcoidosis. However, once disease is identified, PET should be used to determine the response to therapy as well as the burden of active extra-cardiac disease. Notably, cardiac MRI and PET are more sensitive than echocardiography and clinical criteria, and there is often no reliable reference standard to establish the diagnosis of cardiac sarcoidosis. In cases where the diagnosis cannot be clearly established (i.e. clinical and imaging findings which support cardiac sarcoidosis despite the absence of a biopsy), these imaging tests remain useful for informing prognosis as well as guiding therapies.

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Atrioventricular Block as the Initial Manifestation of Cardiac Sarcoidosis in Middle‐Aged Adults

Cited by 166 publications

References 29 publications

Trifascicular block progressing to complete AV block on exercise: a rare presentation demonstrating the usefulness of exercise testing

Trifascicular block progressing to complete AV block on exercise: a rare presentation demonstrating the usefulness of exercise testing

Rapidly Progressive Atrioventricular Block in a Patient with Sarcoidosis

Multimodality Imaging of Cardiac Sarcoidosis

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