Management of Arrhythmias Related to Cardiac Sarcoidosis

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Abstract

Conduction disease in cardiac sarcoidosis is quite common and likely under-recognized. It also can be the first manifestation of the disease and deserves serious attention and a careful, comprehensive workup. Conduction disease can range from blocks at virtually all levels of the conduction system, and the development of both a wide variety of atrial and ventricular arrhythmias. There are several treatment strategies, and in appropriate patients, pharmacologic along with device therapy may be indicated.

Keywords

Ventricular Tachycardia Ventricular Arrhythmia Catheter Ablation Atrioventricular Block Cardiac Sarcoidosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. 1.
    Chapelon-Abric C, de Zuttere D, Duhaut P, Veyssier P, Wechsler B, Huong DLT, et al. Cardiac sarcoidosis. Medicine. 2004;83:315–34.CrossRefPubMedGoogle Scholar
  2. 2.
    Matsui Y, Iwai K, Tachibana T, Fruie T, Shigematsu N, Izumi T, et al. Clinicopathological study of fatal myocardial sarcoidosis. Ann N Y Acad Sci. 1976;278:455–69.CrossRefPubMedGoogle Scholar
  3. 3.
    Roberts WC, McAllister HA, Ferrans VJ. Sarcoidosis of the heart. A clinicopathologic study of 35 necropsy patients (group 1) and review of 78 previously described necropsy patients (group 11). Am J Med. 1977;63:86–108.CrossRefPubMedGoogle Scholar
  4. 4.
    Schuller JL, Olson MD, Zipse MM, Schneider PM, Aleong RG, Weinberger HD, et al. Electrocardiographic characteristics in patients with pulmonary sarcoidosis indicating cardiac involvement. J Cardiovasc Electrophysiol. 2011;22:1243–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Soejima K, Yada H. The work-up and management of patients with apparent or subclinical cardiac sarcoidosis: with emphasis on the associated heart rhythm abnormalities. J Cardiovasc Electrophysiol. 2009;20:578–83. Wiley Online Library.CrossRefPubMedGoogle Scholar
  6. 6.
    Homsi M, Alsayed L, Safadi B, Mahenthiran J, Das MK. Fragmented QRS complexes on 12-lead ECG: a marker of cardiac sarcoidosis as detected by gadolinium cardiac magnetic resonance imaging. Ann Noninvasive Electrocardiol. 2009;14:319–26.CrossRefPubMedGoogle Scholar
  7. 7.
    Schuller JL, Lowery CM, Zipse M, Aleong RG, Varosy PD, Weinberger HD, et al. Diagnostic utility of signal-averaged electrocardiography for detection of cardiac sarcoidosis. Ann Noninvasive Electrocardiol. 2011;16:70–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, et al. ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2012;2013:e283–352.Google Scholar
  9. 9.
    Betensky BP, Tschabrunn CM, Zado ES, Goldberg LR, Marchlinski FE, Garcia FC, et al. Long-term follow-up of patients with cardiac sarcoidosis and implantable cardioverter-defibrillators. HRTHM. 2012;9:884–91. Elsevier Inc.Google Scholar
  10. 10.
    Birnie DH, Sauer W, Bogun F, Cooper J, Culver DA, Duvernoy C, et al. Heart rhythm society expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis. HRTHM. 2014;11(7):1304–1323. Elsevier (In Press).Google Scholar
  11. 11.
    Kato Y, Morimoto S-I, Uemura A, Hiramitsu S, Ito T, Hishida H. Efficacy of corticosteroids in sarcoidosis presenting with atrioventricular block. Sarcoidosis Vasc Diffuse Lung Dis. 2003;20:133–7.PubMedGoogle Scholar
  12. 12.
    Yodogawa K, Seino Y, Ohara T, Takayama H, Katoh T, Mizuno K. Effect of corticosteroid therapy on ventricular arrhythmias in patients with cardiac sarcoidosis. Ann Noninvasive Electrocardiol. 2011;16:140–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Yoshida Y, Morimoto S, Hiramitsu S, Tsuboi N, Hirayama H, Itoh T. Incidence of cardiac sarcoidosis in Japanese patients with high-degree atrioventricular block. Am Heart J. 1997;134:382–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Kandolin R, Lehtonen J, Kupari M. Cardiac sarcoidosis and giant cell myocarditis as causes of atrioventricular block in young and middle-aged adults. Circ Arrhythm Electrophysiol. 2011;4:303–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Gozo EG, Cosnow I, Cohen HC, Okun L. The heart in sarcoidosis. Chest. 1971;60:379–88. American College of Chest Physicians.CrossRefPubMedGoogle Scholar
  16. 16.
    Abeler V. Sarcoidosis of the cardiac conducting system. Am Heart J. 1979;97:701–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Ton K, Schulman S, Lima J, Tandri H. Cardiac sarcoidosis presenting as sick sinus syndrome and recurrent ventricular tachycardia. HRS Journal of the American College of Cardiology 2014;63(125):1–1.Google Scholar
  18. 18.
    Viles-Gonzalez JF, Pastori L, Fischer A, Wisnivesky JP, Goldman MG, Mehta D. Supraventricular arrhythmias in patients with cardiac sarcoidosis: prevalence, predictors and clinical implications. Chest. 2013;143:1085–90.CrossRefPubMedGoogle Scholar
  19. 19.
    Zipse MM, Schuller JL, Katz DF, Steckman DA, Gonzalez JE, Sung RK, et al. Atrial arrhythmias are common and arise from diverse mechanisms in patients with cardiac sarcoidosis. Heart Rhythm 2013;10(S309):1–2.Google Scholar
  20. 20.
    Cain MA, Metzl MD, Patel AR, Addetia K. Cardiac sarcoidosis detected by Late Gadolinium enhancement and prevalence of atrial arrhythmias. Am J Cardiol. 2014;113:1556–60.CrossRefPubMedGoogle Scholar
  21. 21.
    Schuller JL, Zipse M, Crawford T, Bogun F, Beshai J, Patel AR, et al. Implantable cardioverter defibrillator therapy in patients with cardiac sarcoidosis. J Cardiovasc Electrophysiol. 2012;23:925–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Willner JM, Viles-Gonzalez JF, Coffey JO, Morgenthau A, Mehta D. Catheter ablation of atrial arrhythmias in cardiac sarcoidosis. J Cardiovasc Electrophysiol. 2014;25:958–63.Google Scholar
  23. 23.
    Winters SL, Cohen M, Greenberg S, Stein B, Curwin J, Pe E, et al. Sustained ventricular tachycardia associated with sarcoidosis: assessment of the underlying cardiac anatomy and the prospective utility of programmed ventricular stimulation, drug therapy and an implantable antitachycardia device. JAC. 1991;18:937–43.CrossRefGoogle Scholar
  24. 24.
    Koplan BA, Soejima K, Baughman K, Epstein LM, Stevenson WG. Refractory ventricular tachycardia secondary to cardiac sarcoid: electrophysiologic characteristics, mapping, and ablation. HRTHM. 2006;3:924–9.Google Scholar
  25. 25.
    Jefic D, Joel B, Good E, Morady F, Rosman H, Knight B, et al. Role of radiofrequency catheter ablation of ventricular tachycardia in cardiac sarcoidosis: report from a multicenter registry. Heart Rhythm. 2009;6:189–95.CrossRefPubMedGoogle Scholar
  26. 26.
    Banba K, Kusano KF, Nakamura K, Morita H, Ogawa A, Ohtsuka F, et al. Relationship between arrhythmogenesis and disease activity in cardiac sarcoidosis. HRTHM. 2007;4:1292–9.Google Scholar
  27. 27.
    Furushima H, Chinushi M, Sugiura H, Kasai H, Washizuka T, Aizawa Y. Ventricular tachyarrhythmia associated with cardiac sarcoidosis: its mechanisms and outcome. Clin Cardiol. 2004;27:217–22.CrossRefPubMedGoogle Scholar
  28. 28.
    Fleming HA, Bailey SM. Sarcoid heart disease. J R Coll Physicians Lond. 1981;15:245.PubMedGoogle Scholar
  29. 29.
    Uusimaa P, Ylitalo K, Anttonen O, Kerola T, Virtanen V, Pääkkö E, et al. Ventricular tachyarrhythmia as a primary presentation of sarcoidosis. Europace. 2008;10:760–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Stees CS, Khoo MSC, Lowery CM, Sauer WH. Ventricular tachycardia storm successfully treated with immunosuppression and catheter ablation in a patient with cardiac sarcoidosis. J Cardiovasc Electrophysiol. 2011;22:210–3.PubMedGoogle Scholar
  31. 31.
    Yazaki Y, Isobe M, Hiroe M, Morimoto S-I, Hiramitsu S, Nakano T, et al. Prognostic determinants of long-term survival in Japanese patients with cardiac sarcoidosis treated with prednisone. Am J Cardiol. 2001;88:1006–10. Elsevier.CrossRefPubMedGoogle Scholar
  32. 32.
    Mohsen A, Jimenez A, Hood RE, Dickfeld T, Saliaris A, Shorofsky S, et al. Cardiac sarcoidosis: electrophysiological outcomes on long-term follow-up and the role of the implantable cardioverter-defibrillator. J Cardiovasc Electrophysiol. 2014;25(2):171–76.Google Scholar
  33. 33.
    Zipse MM, Sauer WH. Electrophysiologic manifestations of cardiac sarcoidosis. Curr Opin Pulm Med. 2013;19:485–92.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Section of Cardiac Electrophysiology, Division of CardiologyUniversity of Colorado HospitalAuroraUSA

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