Cardiac resynchronization therapy response in cardiac sarcoidosis

Abstract

Introduction: Cardiac sarcoidosis (CS) is a nonischemic cardiomyopathy (NICM) characterized by infiltration of noncaseating granulomas involving the heart with highly variable clinical manifestations that can include conduction abnormalities and systolic heart failure. Cardiac resynchronization therapy (CRT) has shown significant promise in NICM, though little is known about its efficacy in patients with CS. Objective: To determine if CRT improved cardiac remodeling in patients with CS. Methods: We retrospectively reviewed all patients with a clinical or histological diagnosis of CS who underwent CRT implantation at the Mayo Clinic enterprise from 2000 to 2021. Baseline characteristics, imaging parameters, heart failure hospitalizations and need for advanced therapies, and major adverse cardiac events (MACE) were assessed.Results: Our cohort was comprised of 55 patients with 61.8% male and a mean age of 58.7 ± 10.9 years. Eighteen (32.7%) patients had definite CS, 21 (38.2%) had probable CS, while 16 (29.1%) had presumed CS, and 26 (47.3%) with extracardiac sarcoidosis. The majority underwent CRT-D implantation (n = 52, 94.5%) and 3(5.5%) underwent CRT-P implantation with 67.3% of implanted devices being upgrades from prior pacemakers or implantable cardioverter defibrillators. At 6 months postimplantation there was no significant improvement in ejection fraction (34.8 ± 10.9% vs. 37.7 ± 14.2%, p = .331) or left ventricular end-diastolic diameter (58.5 ± 10.2 vs. 57.5 ± 8.1 mm, p = .236), though mild improvement in left ventricular end systolic diameter (49.1 ± 9.9 vs. 45.7± 9.9 mm, p < .0001). Within the first 6 months postimplantation, 5 (9.1%) patients sustained a heart failure hospitalization.At a mean follow-up of 4.1± 3.7 years, 14 (25.5%) patients experienced a heart

Diagnosis and Treatment of Cardiac Sarcoidosis

“…A recent investigation of 55 CS patients who underwent CRT implantation (94.5% CRT-D) showed no significant improvement in LVEF at 6 months postimplantation. 52 After a follow-up of 4.1±3.7 years and despite CRT and optimal medical management, 34.5% of patients either died or underwent advanced HF therapies. 52 Females CRT recipients with CS may have fewer adverse events than their male counterparts.…”

“…52 After a follow-up of 4.1±3.7 years and despite CRT and optimal medical management, 34.5% of patients either died or underwent advanced HF therapies. 52 Females CRT recipients with CS may have fewer adverse events than their male counterparts. 53 Heart transplantation and ventricular assist device should be considered in CS patients with endstage HF despite medical and interventional therapies.…”

Management of the arrhythmic manifestations of cardiac sarcoidosis

“…In the overall population, there was no significant improvement in left ventricular function (average LV EF 34.8% at baseline, 37.7% at 6 months) or left ventricular end-diastolic dimensions (58.5 mm at baseline, 57.5 mm at 6 months). Poor response to CRT was thought to be due to myocardial scarring and fibrosis in advanced CS ( 40 ).…”

Trends in the 30-year span of noninfectious cardiovascular implantable electronic device complications in Olmsted County

“…In recent years, we have witnessed an expansion in the indications for CIED implantation. 1 , 2 , 3 , 4 , 5 CIEDs have augmented patients’ quality of life, reduced hospitalization length, and reduced mortality. 6 , 7 , 8 …”