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Europace Advance Access originally published online on May 2, 2008
Europace 2008 10(6):760-766; doi:10.1093/europace/eun110
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

VENTRICULAR TACHYCARDIA

Ventricular tachyarrhythmia as a primary presentation of sarcoidosis

Paavo Uusimaa1,*, Kari Ylitalo1, Olli Anttonen2, Tuomas Kerola2, Vesa Virtanen3, Eija Pääkkö4 and Pekka Raatikainen1

1 Department of Internal Medicine, Division of Cardiology, University of Oulu, PO Box 5000, 90014 Oulu, Finland; 2 Päijät-Häme Central Hospital, Lahti, Finland; 3 Heart Center, University of Tampere, Tampere, Finland; 4 Department of Radiology, University of Oulu, Oulu, Finland

Aims: Sarcoidosis is a multisystem, granulomatous disease with occasional cardiac manifestations. The clinical course of patients with ventricular tachyarrhythmias as a primary presentation of sarcoidosis is mostly unknown.

Methods and results: We describe nine patients (four males and five females) in whom sarcoidosis manifested as ventricular tachycardia (VT). The age of the patients was 53 ± 10 years (range 33–68). The disease was diagnosed by endomyocardial biopsy in eight patients and by lymph node biopsy in one patient. The presenting arrhythmia varied from non-sustained VT to incessant VT and ventricular fibrillation. All patients received implantable cardioverter defibrillator (ICD) and anti-arrhythmic medication. High-dose steroid treatment was used in eight cases. During the follow-up (50 ± 34 months), five patients underwent appropriate ICD therapies and non-sustained VT episodes were detected in four patients. Two patients developed incessant VT, which was treated by catheter ablation. One patient was referred for heart transplantation.

Conclusion: Our data indicate that sarcoidosis can manifest as VT without any detectable systemic findings. This makes sarcoidosis an important diagnostic consideration in patients with VT of unknown origin. Arrhythmia control in cardiac sarcoidosis is difficult, and all modern treatments including high-dose steroids, anti-arrhythmic drugs, ICD, and catheter ablation are needed to suppress the arrhythmias.

Key Words: Catheter ablation, Implantable cardioverter defibrillator, Sarcoidosis, Ventricular tachycardia

* Corresponding author. Tel: +358 8 315 3701; fax: +358 8 315 2127.E-mail address: paavo.uusimaa{at}oulu.fi

Manuscript submitted 5 February 2008. Accepted after revision 5 April 2008.


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