cardiovascular disorders
Cardiac Sarcoidosis
Treatment of Cardiac Sarcoidosis
Corticosteroids Sometimes other immunosuppressive drugs Permanent pacemaker and/or implantable cardioverter-defibrillator (ICD) Sometimes antiarrhythmic drugs (avoiding class I drugs) Sometimes transcatheter ablation Heart failure therapy (including transplantation) as required Standard Treatment itself are given, including corticosteroids and sometimes immunosuppressants (eg, Cardiac treatment is focused on treatment and prevention of arrhythmias. Recommendations for treatment of bradyarrhythmias or tachyarrhythmias follow that for other arrhythmogenic cardiomyopathies including an ICD for prevention of sudden death (see also table Indications for Implantable Cardioverter-Defibrillators in Ventricular Tachycardia and Ventricular Fibrillation ). An ICD is recommended for patients with prior sustained VT or resuscitated cardiac arrest or severe right or left ventricular systolic dysfunction. An ICD also may be useful (class IIa indication) for patients with any major risk factor for sudden death, including prior syncope, non-sustained ventricular tachycardia, or moderate right or left ventricular systolic dysfunction. ), an ICD platform is preferred (each a class IIa recommendation). The Heart Rhythm Society cardiac sarcoid consensus document also suggested an ICD should be considered (class IIb recommendation) in patients with cardiac sarcoidosis with a left ventricular ejection fraction in the 35% to 49% range and/or a right ventricular ejection fraction < 40% despite optimal medical therapy for heart failure and use of immunosuppressants in patients with active inflammation ( Treatment reference ). may be given as necessary to control frequently recurrent ventricular tachycardias and/or other tachyarrhythmias. If drugs (and adequate anti-inflammatory therapy) do not control VT, electrophysiologic studies may be done to identify the origin of the arrhythmia (often a reentrant site) that can then be treated using Ablation for Cardiac Arrhythmia . Heart failure therapy typically includes a beta-blocker (watching for the possibility of worsening AV conduction), an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker, and a mineralocorticoid receptor antagonist. Newer pharmacological treatments for dilated cardiomyopathy, including angiotensin receptor neprilysin inhibitors and sodium-glucose cotransporter 2 inhibitors have been less well studied in patients with sarcoidosis. The frequent coexistence of left bundle branch block in patients with sarcoidosis dilated cardiomyopathy makes Cardiac Resynchronization Therapy (CRT) attractive. Heart transplantation may be considered. 1.Birnie DH, Sauer WH, Gogun F, et al: HRS Expert Consensus Statement on the Diagnosis and Management of Arrhythmias Associated with Cardiac Sarcoidosis.Heart Rhythm11:1304–1323, 2014. doi: 10.1016/j.hrthm.2014.03.043 