Arrhythmias in Cardiac Sarcoidosis Bench to Bedside
Lynda E. Rosenfeld, Mina K. Chung, Clifford V. Harding, Paolo Spagnolo, Johan Grünewald, Jason Appelbaum, William H. Sauer, Daniel A. Culver, José A. Joglar, Ben A. Lin, Christine Jellis, Timm-Michael Dickfeld, Deborah Kwon, Edward J. Miller, Paul Cremer, Frank Bogun, Jordana Kron, Ashley Bock, Davendra Mehta, Paul Leis, Konstantinos C. Siontis, Elizabeth S. Kaufman, Thomas Crawford, Peter Zimetbaum, Edwin Zishiri, Jagmeet P. Singh, Kenneth A. Ellenbogen, Jonathan Chrispin, Syed M. Quadri, Logan Vincent, Kristen K. Patton, Steven Kalbfleish, Thomas Callahan, Francis Murgatroyd, Marc A. Judson, David H. Birnie, David R. Okada, Christopher Maulion, Pavan Bhat, Lavanya Bellumkonda, Ron Blankstein, Richard K. Cheng, Maryjane Farr, Jerry D. Estep
Abstract
Cardiac sarcoidosis is a component of an often multiorgan granulomatous disease of still uncertain cause. It is being recognized with increasing frequency, mainly as the result of heightened awareness and new diagnostic tests, specifically cardiac magnetic resonance imaging and 18 F-fluorodeoxyglucose positron emission tomography scans. The purpose of this case-based review is to highlight the potentially life-saving importance of making the early diagnosis of cardiac sarcoidosis using these new tools and to provide a framework for the optimal care of patients with this disease. We will review disease mechanisms as currently understood, associated arrhythmias including conduction abnormalities, and atrial and ventricular tachyarrhythmias, guideline-directed diagnostic criteria, screening of patients with extracardiac sarcoidosis, and the use of pacemakers and defibrillators in this setting. Treatment options, including those related to heart failure, and those which may help clarify disease mechanisms are included.