A Systematic Treatment Approach to Ventricular Tachycardia in Cardiac Sarcoidosis
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 electrophysiologic 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, 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 (RFCA) 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 RFCA. 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 ms vs. 183±22 ms; p<0.05). After a 33-month follow-up after the RFCA, 6 of 14 patients experienced VT recurrence. The number of VTs sustained during electrophysiological study was higher in the patients with than without VT recurrence (3.7±1.4 vs. 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.
- Received April 24, 2013.
- Revision received April 2, 2014.
- Accepted April 8, 2014.