HRS Expert Consensus Statement on the Diagnosis and Management of Arrhythmias Associated With Cardiac Sarcoidosis

Birnie, David H.; Sauer, William H.; Bogun, Frank; Cooper, Joshua M.; Culver, Daniel A.; Duvernoy, Claire S.; Judson, Marc A.; Kron, Jordana; Mehta, Davendra; Nielsen, Jens Cosedis; Patel, Amit R.; Ohe, Tohru; Raatikainen, Pekka; Soejima, Kyoko

doi:10.1016/j.hrthm.2014.03.043

Cited by 1,179 publications

(1,501 citation statements)

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“…The availability of these guidelines has also been complemented with rapid and landmark advances in myocardial imaging modalities. The development of the guidelines and imaging techniques has undoubtedly served to enhance the early detection of sarcoidosis, thus increasing the incidence of this disease 10, 11, 26, 27…”

Section: Discussionmentioning

confidence: 99%

“…Patients with sarcoidosis with concomitant cardiovascular manifestations have more complications and a greater risk of sudden death 7, 8. Thus, there is considerable interest in identifying patients with sarcoidosis with concomitant cardiovascular manifestations 9, 10…”

Section: Introductionmentioning

confidence: 99%

“…Rather than placing additional emphasis on histologic diagnoses of cardiac sarcoidosis, the updated guidelines highlighted the presence of cardiovascular manifestations (eg, atrioventricular block and ventricular arrhythmias) to diagnose sarcoidosis with presumed cardiac involvement 11, 12. In addition, the 2014 Heart Rhythm Society consensus statement highlighted the utilization and role of implantable cardioverter‐defibrillators (ICDs) for the primary and secondary prevention of sudden cardiac death in patients with sarcoidosis as an important direction for future research 10. Since these guidelines were implemented, data reporting hospitalization trends and outcomes in sarcoidosis are lacking.…”

Section: Introductionmentioning

confidence: 99%

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Hospitalization Rates, Prevalence of Cardiovascular Manifestations, and Outcomes Associated With Sarcoidosis in the United States

Patel

Kalra

Doshi

et al. 2018

JAHA

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BackgroundRecent trends of hospitalizations and in‐hospital mortality are not well defined in sarcoidosis. We examined aforementioned trends and prevalence of cardiovascular manifestations and explored rates of implantable cardioverter‐defibrillator implantation in hospitalizations with sarcoidosis.Methods and ResultsUsing data from the National Inpatient Sample, a retrospective population cohort from 2005 to 2014 was studied. To identify sarcoidosis, an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) diagnosis code was used. We excluded hospitalizations with myocardial infarction, coronary artery disease, and ischemic cardiomyopathy. Cardiovascular manifestations were defined by the presence of diagnosis codes for conduction disorders, arrhythmias, heart failure, nonischemic cardiomyopathy, and pulmonary hypertension. A total of 609 051 sarcoidosis hospitalizations were identified, with an age of 55±14 years, 67% women, and 50% black. The number of sarcoidosis hospitalizations increased from 2005 through 2014 (138 versus 175 per 100 000, P trend<0.001). We observed declining trends of unadjusted in‐hospital mortality (6.5 to 4.9 per 100 sarcoidosis hospitalizations, P trend<0.001). Overall ≈31% (n=188 438) of sarcoidosis hospitalizations had coexistent cardiovascular manifestations of one or more type. Heart failure (≈16%) and arrhythmias (≈15%) were the most prevalent cardiovascular manifestations. Rates of implantable cardioverter‐defibrillator placement were ≈7.5 per 1000 sarcoidosis hospitalizations (P trend=0.95) during the study period. Black race was associated with 21% increased risk of in‐hospital mortality (odds ratio, 1.21; 95% confidence interval, 1.16–1.27 [P<0.001]).ConclusionsSarcoidosis hospitalizations have increased over the past decade with a myriad of coexistent cardiovascular manifestations. Black race is a significant predictor of in‐hospital mortality, which is declining. Further efforts are needed to improve care in view of low implantable cardioverter‐defibrillator rates in sarcoidosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hospitalization Rates, Prevalence of Cardiovascular Manifestations, and Outcomes Associated With Sarcoidosis in the United States

Patel

Kalra

Doshi

et al. 2018

JAHA

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“…Pathological electrocardiographic findings comprehended those described to be general risk stratifiers for sudden cardiac death,11 those integrated in the Heart Rhythm Society's (HRS's) expert consensus statement on the diagnosis and management of CS‐associated arrhythmias,12 and those exposed in the revised Japanese Ministry of Health and Welfare Guidelines (JMHWG) 13…”

Section: Methodsmentioning

confidence: 99%

“…Standard echocardiographic views were obtained with the patient in the left lateral decubitus position in 2D and colour tissue Doppler imaging modes and by use of a commercially available ultrasound scanner (Vivid 7, General Electric Medical Health, Waukesha, WI, USA; iE 33, Philips Medical Systems, Koninklijke N.V., Hamburg, Germany). Pathological echocardiographic results were pre‐defined in line with the HRS consensus statement12 and the revised JMHWG 13. Accordant with electrocardiographic analysis, all echocardiographic studies were performed by versed cardiologists.…”

Section: Methodsmentioning

confidence: 99%

Cardiovascular magnetic resonance imaging and clinical performance of somatostatin receptor positron emission tomography in cardiac sarcoidosis

et al. 2017

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AimsCardiac affection constitutes a major limiting condition in systemic sarcoidosis. The primary objective of this study was to investigate the persistence rate of cardiac sarcoid involvement by cardiovascular magnetic resonance (CMR) imaging in patients diagnosed with cardiac sarcoidosis (CS). Moreover, we examined the additional insights into myocardial damage's characteristics gained by somatostatin receptor scintigraphy.Methods and resultsIn a pilot study, we had previously identified cardiac involvement—diagnosed by CMR imaging—to be present in 29 of 188 patients (15.4%) with histologically proven, extra‐CS. Out of these initial 29 CS‐positive patients, 27 patients (49.9 ± 11.8 years, 59.3% male) were presently re‐examined and underwent a second CMR study and complementary standard clinical testing. Somatostatin receptor scintigraphy using the ligand 68Ga‐DOTATOC was additionally performed when clinically indicated (17 patients). Within a median follow‐up period of 2.6 years, none of the initial 29 patients deceased or experienced aborted sudden cardiac death. However, two patients developed third‐degree atrioventricular block that required device therapy. Among the 27 re‐examined CS patients, pathological CMR findings persisted in 14 of 27 patients (51.9%). CS remission was primarily due to a resolution of acute inflammatory processes. 68Ga‐DOTATOC positron emission tomography/computed tomography (PET/CT) identified one patient with regions of raised tracer uptake that concorded with acute inflammatory changes, as assessed by CMR; this patient received no immunosuppressive medication at the time of PET/CT execution.ConclusionsWithin follow‐up, CS persisted in barely half the patients, and the patients were not afflicted with cardiac death. Additional 68Ga‐DOTATOC PET/CT allowed for visualization of acute myocardial inflammation.

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A 51-Year-Old Man With Exercise-Induced Syncope

2017

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HRS Expert Consensus Statement on the Diagnosis and Management of Arrhythmias Associated With Cardiac Sarcoidosis

Cited by 1,179 publications

References 76 publications

Hospitalization Rates, Prevalence of Cardiovascular Manifestations, and Outcomes Associated With Sarcoidosis in the United States

Hospitalization Rates, Prevalence of Cardiovascular Manifestations, and Outcomes Associated With Sarcoidosis in the United States

Cardiovascular magnetic resonance imaging and clinical performance of somatostatin receptor positron emission tomography in cardiac sarcoidosis

A 51-Year-Old Man With Exercise-Induced Syncope

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