VENTRICULAR ARRHYTHMIA: AN UNCOMMON INITIAL PRESENTATION OF SARCOIDOSIS
Dabbagh M, Gorgis S, Mawri S, Iyer G, Singh G, and Hudson M. VENTRICULAR ARRHYTHMIA: AN UNCOMMON INITIAL PRESENTATION OF SARCOIDOSIS. J Am Coll Cardiol 2019; 73(9):2944.
J Am Coll Cardiol
Background: Sarcoidosis is a common disorder of unknown etiology that usually presents with pulmonary manifestations. Although cardiac sarcoidosis is well described in the literature, it is uncommon for arrhythmia to be a presenting manifestation of this disease. Case: A 42-year-old female with a history of asthma presented to the hospital with palpitations and lightheadedness; she was found to be in wide complex tachycardia that was initially treated with amiodarone. She eventually developed symptomatic hemodynamic instability requiring defibrillation. Subsequently, she developed recurrent non-sustained ventricular tachycardia (VT) of different morphologies. Cardiac testing revealed left ventricular ejection fraction of 44% with focal wall motion abnormality. Ischemia was suspected, but left heart catheterization showed no angiographic evidence of coronary disease. Cardiac MRI revealed severe hypokenesis to akinesis of the basal to mid lateral wall extending into the anterolateral and inferior walls associated with sub-endocardial delayed enhancement affecting up to 50% wall thickness. It also showed mediastinal lymphadenopathy. Decision-making: Given her symptomatic status, she underwent successful focal VT ablation arising from the basal inferior wall. Given the unclear etiology of the arrhythmia in the presence of mediastinal lymphadenopathy, a lymph node biopsy was performed which was positive for sarcoidosis. A dual chamber implantable cardioverter-defibrillator (ICD) was placed prior to discharge. The patient was instructed to start prednisone treatment 4 weeks after ICD placement. Conclusion: Cardiac arrhythmias can be the presenting clinical manifestation of sarcoidosis. Early recognition of sarcoidosis as a possible etiology of these arrhythmias can lead to appropriate lifesaving treatments.