Mapping and Ablation of Ventricular Arrhythmias in Patients with Cardiac Sarcoidosis

Zipse, Matthew M.; Tzou, Wendy S.; Sauer, William H.

doi:10.1002/9781119152637.ch75

Cited by 1 publication

(3 citation statements)

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“…16,27 In addition to reentry, the inflammation of CS can result in arrhythmias due to triggered activity and abnormal automaticity. 28,29…”

Section: Mechanisms Of Arrhythmiamentioning

confidence: 99%

“…13 The above milieu of abnormal atrial myocardium results in arrhythmia via mechanisms of abnormal automaticity, macroreentry, and triggered activity, with 1 study estimating the rates of these mechanisms in CS patients with nonatrial fibrillation atrial arrhythmias as 47%, 42%, and 11%, respectively. 29 More recent literature suggests that atrial arrhythmias may be more common than VA. 13,28 One analysis demonstrated a 36% rate of atrial arrhythmias in patients with extracardiac CS and LGE positivity on CMR versus a 27% rate of ventricular arrhythmia. 37 This same study found that those with evidence of cardiac involvement as demonstrated by LV LGE versus those without cardiac involvement (lack of LGE) had a threefold likelihood of developing atrial arrhythmias after adjusting for LVEF, left atrial volumes or the presence of pulmonary sarcoidosis.…”

Section: Ventricular Arrhythmiamentioning

confidence: 99%

“…The above milieu of abnormal atrial myocardium results in arrhythmia via mechanisms of abnormal automaticity, macroreentry, and triggered activity, with 1 study estimating the rates of these mechanisms in CS patients with nonatrial fibrillation atrial arrhythmias as 47%, 42%, and 11%, respectively. 29…”

Section: Mechanisms Of Arrhythmiamentioning

confidence: 99%

See 2 more Smart Citations

Arrhythmia in Cardiac Sarcoidosis

Locke¹,

Gurin

Sabe³

et al. 2020

Cardiology in Review

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Cardiac sarcoidosis (CS) is a complex disease that can manifest as a diverse array of arrhythmias. CS patients may be at higher risk for sudden cardiac death (SCD), and, in some cases, SCD may be the first presenting symptom of the underlying disease. As such, identification, risk stratification, and management of CS-related arrhythmia are crucial in the care of these patients. Left untreated, CS carries significant arrhythmogenic morbidity and mortality. Cardiac manifestations of CS are a consequence of an inflammatory process resulting in the myocardial deposition of noncaseating granulomas. Endomyocardial biopsy remains the gold standard for diagnosis; however, biopsy yield is limited by the patchy distribution of the granulomas. As such, recent guidelines have improved clinical diagnostic pathways relying on advanced cardiac imaging to help in the diagnosis of CS. To date, corticosteroids are the best studied agent to treat CS but are associated with significant risks and limited benefits. Implantable cardioverter-defibrillators have an important role in SCD risk reduction. Catheter ablation in conjunction with antiarrhythmics seems to reduce ventricular arrhythmia burden. However, the appropriate selection of these patients is crucial as ablation is likely more helpful in the setting of a myocardial scar substrate versus arrhythmia driven by active inflammation. Further studies investigating CS pathophysiology, the pathway to diagnosis, arrhythmogenic manifestations, and SCD risk stratification will be crucial to reduce the high morbidity and mortality of this disease.

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“…16,27 In addition to reentry, the inflammation of CS can result in arrhythmias due to triggered activity and abnormal automaticity. 28,29…”

Section: Mechanisms Of Arrhythmiamentioning

confidence: 99%