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