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The following is a summary of “Cardiac sarcoidosis in patients with recurrent ventricular arrhythmias refractory to endocardial ablation,” published in the August 2024 issue of Cardiology by Nentwich et al.

Cardiac sarcoidosis diagnosis is challenging due to diverse symptoms and potential sampling errors in endomyocardial biopsy (EMB), but early immunosuppression can improve prognosis.

Researchers conducted a retrospective study investigating additional markers supporting the diagnosis of cardiac sarcoidosis by analyzing the single-center cohort of patients with recurrent ventricular arrhythmias (VA) and nonischemic cardiomyopathy after the failure of endocardial ablation.

They analyzed data from 135 patients (mean age 49 y, 63% male) hospitalized for epicardial VA ablation after the failure of endocardial ablation over 4 years. Of this group, 19 patients either had a previous diagnosis of cardiac sarcoidosis or were newly diagnosed. The mean follow-up time was 4.3 years. The analysis included ECG criteria, primary manifestation, histological findings in EMB, history of VT ablation, distribution of scars on MRI, electroanatomical mapping (EAM), PET CT findings, atrial tachycardias, valve disease, and comorbidities.

The results showed that 6 of 19 (32%) patients showed a right bundle block, and 6 of 19 (32%) had AV nodal disease, including 4 patients with AV-block III, 14 patients (73%) primarily presented with VA (including 3 with cardiac arrest). In all 19 patients, cardiac EMB revealed elevated CD68 macrophages and CD3 T lymphocytes; 7 of 19 were positive for granuloma (36.8%), and 6 patients (100%) undergoing PET CT showed acute inflammation. Analysis of scar distribution showed the most common locations were basal anteroseptal, basal inferoseptal, mid inferoseptal, mid inferior, and the septal RV/RVOT (septal substrate in 100%). There is a high correlation between the MRI findings and low voltage in the EAM. All patients received immunosuppressive therapy. No patient died during follow-up, and 1 patient had a high-urgent heart transplant after steroid therapy withdrawal.

Investigators concluded that chronic inflammation may be the underlying cause of unspecified cardiomyopathy and refractory VA, with septal substrate, elevated CD3 lymphocytes, and inflammation suggesting cardiac sarcoidosis, prompting consideration of immunosuppressive therapy.

Source: link.springer.com/article/10.1007/s00392-024-02509-z