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REVIEW

Characteristics and prognosis of patients with cardiac sarcoidosis presenting with atrioventricular block and ventricular arrhythmias

Caleb Carver1* ,  Raheel Ahmed2
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1 Department of Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
2 Department of Cardiology, Royal Brompton and Harefield Hospitals, London, United Kingdom
Brain & Heart, 3515 https://doi.org/10.36922/bh.3515
Submitted: 27 April 2024 | Accepted: 19 August 2024 | Published: 8 October 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Cardiac sarcoidosis (CS) may initially present with life-threatening arrhythmias such as atrioventricular block (AVB) and ventricular arrhythmia (VA), including ventricular tachycardia and ventricular fibrillation. Diagnosing CS is challenging due to subtle or absent findings in routine tests and the low sensitivity of the definitive diagnostic tool, endomyocardial biopsy. CS can also mimic other cardiac conditions such as dilated cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy, and it may occur without any systemic involvement. Consequently, delays in presentation, accurate diagnosis, and initiation of appropriate treatment are frequent. Greater awareness of the condition could improve outcomes for patients with CS. Non-invasive advanced imaging techniques, such as 18F-fluorodeoxyglucose positron emission tomography and cardiac magnetic resonance imaging are essential for diagnosis, although they may not be accessible in all clinical settings. Management of arrhythmias in CS involves conventional therapies in the utilization of antiarrhythmics and non-pharmacological therapy (e.g., implantable devices), but with notable divergences in the use of immunosuppression and a preference for implantable cardioverter defibrillators over permanent pacemakers. This narrative review aimed to outline the clinical features of patients with CS presenting with AVB or VA and examine diagnostic investigations, imaging techniques, treatment approaches, and prognosis based on current research and international guidelines.

Keywords
Cardiac sarcoidosis
Sarcoidosis
Atrioventricular block
Ventricular tachycardia
Ventricular fibrillation
Sudden cardiac death
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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Brain & Heart, Electronic ISSN: 2972-4139 Published by AccScience Publishing
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