The role of ICDs in patients with sarcoidosis–A comprehensive review

Mactaggart, Sebastian; Ahmed, Raheel

doi:10.1016/j.cpcardiol.2024.102483

Cited by 10 publications

(2 citation statements)

References 76 publications

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“…Immunosuppression remains the mainstay of therapy in patients manifesting active inflammation secondary to CS. In addition, there is medical therapy for congestive heart failure as well as defibrillator implantation for patients who have a history or are at risk of sudden cardiac death [ 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Arrhythmias in Cardiac Sarcoidosis: Management and Prognostic Implications

Arunachalam Karikalan,

Yusuf,

El Masry

2024

JCM

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Cardiac sarcoidosis (CS) is characterized by various arrhythmic manifestations ranging from catastrophic sudden cardiac death secondary to ventricular arrhythmia, severe conduction disease, sinus node dysfunction, and atrial fibrillation. The management of CS is complex and includes not only addressing the arrhythmia but also controlling the myocardial inflammation resultant from the autoimmune reaction. Arrhythmic manifestations of CS carry significant prognostic implications and invariably affect long-term survival in these patients. In this review, we focus on management of arrhythmic manifestation of cardiac sarcoidosis as well as risk stratification for sudden cardiac death in these patients.

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Section: Introductionmentioning

confidence: 99%

Arrhythmias in Cardiac Sarcoidosis: Management and Prognostic Implications

Arunachalam Karikalan,

Yusuf,

El Masry

2024

JCM

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“…Inappropriate therapy, however, is a shock that is delivered in the absence of VT or VF, the consequence of which has been previously shown to lead to myocardial dysfunction, advancement of heart failure, and increased mortality [2][3][4]. As we have previously discussed in other works, clinicians are starting to recognise the importance of ICDs in CS, even in those with a potentially normal ejection fraction [5][6][7]. Consequently, as the number of patients who receive ICDs increases, so does the importance of recognising those patient groups who will most benefit from its insertion, and, crucially, those who may not.…”

Section: Introductionmentioning

confidence: 99%

ICD in Cardiac Sarcoidosis: Variables Associated with Appropriate Therapy, Inappropriate Therapy, and Device Complications

Mactaggart,

Ahmed

2024

JoR

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Introduction: Those with cardiac sarcoidosis (CS) are at risk of sudden cardiac death (SCD), which may be prevented using an implantable cardioverter–defibrillator (ICD). There are limited data available that follow the post-procedural outcomes of patients with cardiac sarcoidosis (CS) who have had an ICD implanted. Areas Covered: This review highlights studies that focused on both appropriate and inappropriate therapies in those with an ICD, as well as device complications in this group. There were several variables, including age, sex, ventricular characteristics, and findings on cardiac imaging that were investigated and discussed as influencing factors in predicting appropriate and inappropriate therapies. Conclusions: Adverse events in those with an ICD and CS have been minimally reported in the literature. Individuals diagnosed with CS are at high risk of ventricular arrhythmia, with comparable rates of appropriate therapy but with a higher incidence of side effects and inappropriate therapy. The younger average age of CS patients in comparison to other ICD cohorts warrants the need for further, large-scale, prospective trials with periodic interim follow-ups focused on those with this condition.

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Outcomes of cardiac resynchronization therapy (CRT) in cardiac sarcoidosis patients with a range of ejection fractions

Liu,

Ahmed,

Dulay

et al. 2024

ESC Heart Failure

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AimsIn cardiac sarcoidosis (CS) patients, the benefit of cardiac resynchronization therapy (CRT) remains unclear. We sought to assess the short‐term and long‐term effects of CRT in CS patients with a range of left ventricular (LV) ejection fractions (LVEFs).MethodsConsecutive CS patients with heart failure with reduced ejection fraction (HFrEF; LVEF ≤ 40%), mildly reduced ejection fraction (HFmrEF; LVEF 41%–49%) and preserved ejection fraction (HFpEF; LVEF ≥ 50) treated with CRT under the care of a tertiary UK centre between 2008 and 2023 were reviewed. CRT response was defined by >5% improvement in serial LVEF. The primary endpoint was a composite of all‐cause mortality, cardiac transplantation or unplanned hospitalization for decompensated heart failure. The secondary endpoint included ventricular arrhythmic events.ResultsOf the 100 patients enrolled (age 58 ± 10 years; 71% male), 63 had HFrEF, 17 had HFmrEF and 20 had HFpEF. After short‐term follow‐up (9.8 ± 5.4 months), HFrEF patients demonstrated significant LVEF response (P < 0.01). On Kaplan–Meier analysis (follow‐up 38 ± 32 months), HFrEF non‐responders had significantly worse event‐free survival compared with HFrEF responders for the primary (P < 0.001) and secondary (P = 0.001) endpoints. Despite short‐term LV function improvement, CRT responders still had worse event‐free survival compared with HFmrEF/HFpEF patients for the primary endpoint (P < 0.001). On multivariable Cox analysis, age [hazard ratio (HR) 1.05, 95% confidence interval (CI) 1.01–1.10, P = 0.008] and HFrEF CRT non‐response (HR 12.33, 95% CI 2.45–61.87, P = 0.002) were associated with the primary endpoint.ConclusionsIn CS patients with HFrEF, CRT response is associated with a better long‐term prognosis than non‐response. However, HFrEF CRT responders still have worse long‐term prognosis than HFmrEF/HFpEF patients.

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The role of ICDs in patients with sarcoidosis–A comprehensive review

Cited by 10 publications

References 76 publications

Arrhythmias in Cardiac Sarcoidosis: Management and Prognostic Implications

Arrhythmias in Cardiac Sarcoidosis: Management and Prognostic Implications

ICD in Cardiac Sarcoidosis: Variables Associated with Appropriate Therapy, Inappropriate Therapy, and Device Complications

Outcomes of cardiac resynchronization therapy (CRT) in cardiac sarcoidosis patients with a range of ejection fractions

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