Electrophysiologic manifestations of cardiac sarcoidosis

Purpose of reviewCardiac involvement in sarcoidosis patients is frequently unrecognized with ventricular arrhythmias and sudden cardiac death (SCD) sometimes occurring as its initial presentation. Early involvement of an electrophysiologist as part of a multidisciplinary team is essential to screening, risk stratification, and management of cardiac sarcoidosis patients. This review outlines potential manifestations of cardiac sarcoidosis, as well as diagnostic and treatment strategies.Recent findingsRecent retrospective analyses have shown that the incidence of atrioventricular block, atrial tachyarrhythmias, and ventricular tachyarrhythmias in these patients is substantial. In addition to advanced cardiac imaging, there is a role for ECG, signal-averaged ECG, ambulatory telemetry monitoring, and electrophysiologic testing in the initial evaluation of a patient with suspected cardiac sarcoidosis. There have been recent investigations into the role of implantable cardioverter-defibrillators (ICDs) for SCD prevention with a high rate of appropriate therapies observed. Immunosuppressive therapy, antiarrhythmic drugs, and catheter ablation each also have a role in the reduction of overall arrhythmic burden.SummaryThe electrophysiologist's approach to a patient with cardiac sarcoidosis can aid in diagnosis, risk stratification, and management with antiarrhythmic therapy, catheter ablation, and ICD implantation for the prevention of SCD.