Long-term monitoring of arrhythmias with cardiovascular implantable electronic devices in patients with cardiac sarcoidosis

• Published in: Heart rhythm Vol. 19; no. 3; pp. 352 - 360
• Main Authors: Bakker, Annelies, Mathijssen, Harold, Dorland, Galina, Balt, Jippe C., van Dijk, Vincent F., Veltkamp, Marcel, Akdim, Fatima, Grutters, Jan C., Post, Martijn C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2022
• Subjects: Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - epidemiology; Arrhythmias, Cardiac - etiology; Cardiac sarcoidosis; Cardiovascular implantable electronic device; Death, Sudden, Cardiac - epidemiology; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable - adverse effects; Electronics; Humans; Implantable cardioverter-defibrillator; Implantable loop recorder; Myocarditis - complications; Retrospective Studies; Risk stratification; Sarcoidosis - complications; Sarcoidosis - diagnosis; Sarcoidosis - epidemiology; Sudden cardiac death; Ventricular arrhythmia; Cardiovascular implantable electronic device; Risk stratification; Ventricular arrhythmia; Sudden cardiac death; Cardiac sarcoidosis; Implantable cardioverter-defibrillator; Implantable loop recorder
• ISSN: 1547-5271; 1556-3871
• DOI: 10.1016/j.hrthm.2021.11.025

Risk stratification for sudden cardiac death (SCD) in cardiac sarcoidosis (CS) is challenging in patients without overt cardiac symptoms. The purpose of this study was to determine the incidence of ventricular arrhythmias (VAs) and mortality after long-term monitoring with a cardiovascular implantable electronic device (CIED) in CS patients identified after systematic screening of patients with extracardiac sarcoidosis (ECS). A retrospective study was performed in 547 predominantly Caucasian patients with ECS screened for cardiac involvement. If CS was diagnosed, risk stratification (high vs low risk) for SCD was performed by a multidisciplinary team. The primary endpoint was defined as sustained VA, appropriate implantable cardioverter-defibrillator (ICD) therapy, or cardiac death. In total, 105 patients were included (mean follow-up 33 ± 16 months). An ICD was implanted in 17 high-risk patients (16.2%), whereas 80 low-risk patients (76.1%) received an implantable loop recorder (ILR). Eight low-risk patients (7.6%) did not receive a device. The primary endpoint occurred in 4.8% (n = 5), with an overall annualized event rate of 1.7%. The annualized event rate was 9.8% in high-risk patients and 0.4% in low-risk patients. Nine low-risk patients received an ICD during follow-up, in 7 patients as a result of the ILR recordings. None of these patients required ICD therapy. In CS patients without overt cardiac symptoms at initial presentation the annualized overall event rate was 1.7%; 10% in high-risk patients, but only 0.4% in low-risk patients. In low-risk patients long-term arrhythmia monitoring with an ILR enabled early detection of clinically important arrhythmias without showing impact on prognosis.