Cardiac Sarcoidosis: A Report of Four Cases with Ventricular Tachycardia

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Abstract
Cardiac Sarcoidosis: A Report of Four Cases with Ventricular Tachycardia. Four patients with systemic sarcoidosis who presented with ventricular tachycardia are described. Three of the four patients had biopsy proven cardiac involvement while the fourth had systemic sarcoidosis and fixed thallium scan defects without evidence of coronary artery disease. Antiarrhythmic therapy for these patients was guided by means of electrophysiological testing. Two patients received an automatic implantable cardioverter defibrillator (AICD), one following ineffective ablative surgical treatment. Two other patients had presumed effective drug therapies determined by electrophysiological testing. One of these patients died suddenly 21 months after therapy was initiated. This patient did not have inducible sustained ventricular arrhythmias during baseline electrophysiological study, but was treated for inducible nonsustained arrhythmias. This report expands the number of patients with cardiac sarcoidosis and arrhythmias in the literature and illustrates the difficulty in guiding therapy. Because sarcoid infiltration and subsequent scarring of the myocardium may be progressive, the long‐term effectiveness of surgery, antiarrhythmic medications and corticosteroids may not be predictable. AICD implantation has the potential to remain an effective therapy despite the emergence of new tachyarrhythmias. (J Cardiovasc Electrophysiol, Vol. 1. pp. 214–219, June 1990)