Systematic Treatment Approach to Ventricular Tachycardia in Cardiac Sarcoidosis [RETRACTED]

Abstract

Background— Fatal arrhythmia is commonly observed in cardiac sarcoidosis, but clinical effects of a systematic treatment approach are still uncertain. This study sought to describe both clinical and electrophysiological characteristics and outcomes of systematic treatment approach to ventricular tachycardia (VT) associated with cardiac sarcoidosis. Methods and Results— We enrolled 37 consecutive patients (11 men; age, 56±11 years) with a diagnosis of sustained VT associated with cardiac sarcoidosis. Clinical effects of a systematic treatment approach including medical therapy (both steroid and antiarrhythmic agents), in association with radiofrequency catheter ablation, were evaluated. All patients received antiarrhythmic agents, and 34 received steroid therapy. During a 39-month follow-up, 23 (62%) patients were free from any VT episodes with medical therapy. Multivariable Cox regression analyses revealed that the absence of gallium-67 myocardial uptake was an independent predictor for VT recurrence (hazard ratio, 7.51; 95% confidence interval, 1.65–34.26; P <0.01). Fourteen patients who experienced VT recurrences even while on drug therapy underwent radiofrequency catheter ablation. Electrophysiological study revealed that the mechanisms of VTs could be classified into 2 subgroups: Purkinje-related or scar-related VT. The QRS duration of VT was narrower in Purkinje-related than in scar-related VTs (157±23 versus 183±22 ms; P <0.05). After a 33-month follow-up subsequent to the radiofrequency catheter ablation, 6 of 14 patients experienced VT recurrence. The number of VTs sustained during electrophysiological study was higher in the patients with VT recurrence than in those without (3.7±1.4 versus 1.9±0.8; P <0.01). Conclusions— A systematic treatment approach to cardiac sarcoidosis with VT successfully suppressed VT recurrences in the majority of patients studied.

Long-Term Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients With Cardiac Sarcoidosis

“…2,4,12,23,24 Our findings confirm and extend the results of the previous studies and show that endocardial with adjuvant epicardial mapping and CA when indicated (ie, recurrent VT or persistent inducibility after endo-only ablation) provides good long-term outcomes, with 40% of patients having no VT at 6-year follow-up and infrequent or isolated recurrent episodes in most of the remaining patients ( Figure 5). However, the efficacy of CA in this patient sample certainly seems lower than other patient cohorts with scar-related VT. 15,25,26 In CS, unlike other forms of scar-related VTs, active inflammation plays a role in promoting VT either by triggered activity or abnormal automaticity or by creating functional slow-conduction pathways within inflamed tissue.…”

Bedside to Bench – A Difficult Journey: An Irregular Wide QRS Tachycardia

“…As per the guidelines, FDG-PET is necessary to look for myocardial inflammation. Patchy uptake on FDG-PET is suggestive of inflammation and using immunosuppression may be helpful in the treatment of VT [6].…”

Time Course and Factors Correlating With Ventricular Tachyarrhythmias After Introduction of Steroid Therapy in Cardiac Sarcoidosis

“…19 Electrical storm (ES) was defined as the occurrence of 3 episodes of VTs including an appropriate ICD therapy, separated by 5 minutes during a 24-hour period.…”

“…Gallium scintigraphy and PET are now routinely used to detect inflammation of CS. 16,18,19,33,34 Cardiac PET has high sensitivity and specificity. 14,18,35 In this study, almost all of the patients had positive PET examination.…”