Elsevier

Heart Rhythm

Volume 6, Issue 2, February 2009, Pages 189-195
Heart Rhythm

Original-clinical
Ablation
Role of radiofrequency catheter ablation of ventricular tachycardia in cardiac sarcoidosis: Report from a multicenter registry

https://doi.org/10.1016/j.hrthm.2008.10.039Get rights and content

Background

Management of ventricular tachycardia (VT) is challenging in patients with cardiac sarcoidosis.

Objective

The purpose of this study was to assess the response of VT in patients with cardiac sarcoidosis to medical therapy and radiofrequency ablation.

Methods

Forty-two patients with a diagnosis of cardiac sarcoidosis based on the Japanese Health Ministry criteria were followed. When VT occurred, a stepwise approach was used: implantable cardioverter-defibrillator placement, immunosuppressive agents, antiarrhythmic medications, then radiofrequency ablation.

Results

In nine patients (age 46.7 ± 8.6 years; ejection fraction 42 ± 14%), VT was not controlled by medical therapy, and radiofrequency ablation was performed. A total of 44 VTs (mean cycle length 348 ± 78 ms) were induced. Endocardial radiofrequency ablation was performed in eight patients (right ventricular in 5, left ventricular in 3) and epicardial radiofrequency ablation in one patient. In 4 of 5 patients with right ventricular VTs, a peritricuspid circuit was identified. Critical areas were identified for 21 (48%) of 44 VTs, resulting in elimination of 31 (70%) of 44 VTs. The most frequent VT circuit was reentry in the peritricuspid area. This type of VT was eliminated in all patients. Arrhythmic events decreased from 271 ± 363 episodes preablation to 4.0 ± 9.7 postablation. All patients had either a decrease (n = 4) or complete elimination (n = 5) of VT during mean follow-up of 19.8 ± 19.6 months.

Conclusion

Catheter ablation of VT in patients with cardiac sarcoidosis refractory to medical therapy is effective in eliminating VT or markedly reducing the VT burden. The disease process in cardiac sarcoidosis often involves a specific area in the basal right ventricle predisposing to peritricuspid reentry.

Section snippets

Patient characteristics

A total of 37 consecutive patients from the arrhythmia clinic at the University of Michigan who had cardiac sarcoidosis based on the Japanese Health and Welfare Ministry criteria2 were followed. Another five patients from other centers (St. John Hospital, Detroit, MI, USA, and University of Chicago Medical Center, Chicago, IL, USA) who were enrolled in a multicenter registry of cardiac sarcoidosis also were included in the analysis (Table 1). This registry was initiated at the University of

Cardiac sarcoidosis and VT

A total of 42 patients were included in the analysis. Twenty-one (50%) of the 42 patients developed sustained VT/VF during follow-up (including the 12 patients who presented with sustained ventricular arrhythmias) and required antiarrhythmic therapy in addition to steroid therapy (Table 2). In 12 (57%) of the 21 patients, pharmacologic therapy was effective in controlling VT. In 9 (43%) patients, an ablation procedure was performed after they did not respond to medical treatment. The diagnosis

Main findings

In this study, 50% of patients with cardiac sarcoidosis required treatment for ventricular arrhythmias. Arrhythmia control could not be achieved with a combination of steroids and antiarrhythmic drugs in almost half of the patients. In these patients, radiofrequency catheter ablation was effective in eliminating VT or in markedly reducing the VT burden. In this study, which is the largest report to date of patients with cardiac sarcoidosis undergoing radiofrequency catheter ablation, the most

Conclusion

Medical therapy is ineffective in approximately 50% of patients with cardiac sarcoidosis who develop VT. Radiofrequency catheter ablation of VT in patients with cardiac sarcoidosis refractory to antiarrhythmic and immunosuppressive therapy often is effective in eliminating VT or in markedly reducing the VT burden. The arrhythmogenic substrate of VT often involves the peritricuspid area in the right ventricle.

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