Arrhythmic prognosis according to left ventricular systolic dysfunction severity in cardiac sarcoidosis

• Published in: Heart rhythm
• Main Authors: Kim, B. Michelle, Sykora, Daniel, Rosenbaum, Andrew N., Ahmed, Enas, Churchill, Robert A., Bratcher, Melanie, Elwazir, Mohamed Y., Bois, John P., Giudicessi, John R., Sugrue, Alan M., Killu, Ammar M., Kapa, Suraj, Deshmukh, Abhishek J., Asirvatham, Samuel J., Cooper, Leslie T., Abou Ezzeddine, Omar F., Siontis, Konstantinos C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 28.08.2024
• Subjects: Cardiac sarcoidosis; Cardiovascular implantable electronic device; Heart failure; Sudden cardiac death; Ventricular arrhythmia; Cardiovascular implantable electronic device; Heart failure; CI; Ventricular arrhythmia; FDG; LVEF; CMR; HR; LV; ICD; Sudden cardiac death; Cardiac sarcoidosis; LVAD; CS; VF; PET; VT
• ISSN: 1547-5271; 1556-3871; 1556-3871
• DOI: 10.1016/j.hrthm.2024.08.049

Current guidelines present varying classes of recommendations for implantable cardioverter-defibrillator (ICD) utilization in patients with cardiac sarcoidosis (CS) and left ventricular ejection fraction (LVEF) <50%. The purpose of this study was to investigate the ventricular arrhythmia risk in CS patients with ICDs and varying degrees of left ventricular systolic dysfunction. The study included CS patients with an ICD and LVEF <50% at index evaluation. The primary outcome was survival free of sustained ventricular tachycardia (VT)/ventricular fibrillation (VF) after ICD implantation and was assessed comparatively for LVEF ≤35% vs 36%–49% and for primary vs secondary prevention ICD indication. The study included 61 patients (median age 57 years; 61% male) with LVEF 36%–49% (n = 23) or LVEF ≤35% (n = 38). An ICD was implanted for secondary prevention in 24% and 44% of the LVEF ≤35% and 36%–49% groups, respectively (P = .11). The primary outcome did not differ between the 2 groups in univariable analysis (LVEF ≤35% vs 36%–49%: hazard ratio [HR] 0.85; 95% confidence interval [CI] 0.39–1.82; P = .67). In multivariable analysis, secondary prevention ICD indication was the only significant predictor of incident sustained VT/VF (HR 2.86; 95% CI 1.23–6.67; P = .015). Mean sustained VT/VF event burden was higher in the secondary compared with the primary prevention ICD patients (0.47 vs 0.11 events per patient-year; P = .005) but did not differ significantly between LVEF ≤35% and 36%–49% patients. CS patients with ICD indications and LVEF 36%–49% carry similarly high arrhythmic risk as those with LVEF ≤35%. Patients with secondary prevention ICDs have the highest overall risk.