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Brain & Heart

REVIEW ARTICLE
Characteristics and prognosis of patients

with cardiac sarcoidosis presenting with
atrioventricular block and ventricular

arrhythmias

Caleb Carver * and Raheel Ahmed 2
1
1 Department of Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
2 Department of Cardiology, Royal Brompton and Harefield Hospitals, London, United Kingdom

Abstract

Cardiac sarcoidosis (CS) may initially present with life-threatening arrhythmias such
as atrioventricular block (AVB) and ventricular arrhythmia (VA), including ventricular
tachycardia and ventricular fibrillation. Diagnosing CS is challenging due to subtle
or absent findings in routine tests and the low sensitivity of the definitive diagnostic
tool, endomyocardial biopsy. CS can also mimic other cardiac conditions such as
dilated cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy, and it
may occur without any systemic involvement. Consequently, delays in presentation,
accurate diagnosis, and initiation of appropriate treatment are frequent. Greater
awareness of the condition could improve outcomes for patients with CS. Non-
invasive advanced imaging techniques, such as 18F-fluorodeoxyglucose positron
emission tomography and cardiac magnetic resonance imaging are essential for
*Corresponding author:
Caleb Carver diagnosis, although they may not be accessible in all clinical settings. Management of
(calebcarver@yahoo.co.uk) arrhythmias in CS involves conventional therapies in the utilization of antiarrhythmics
and non-pharmacological therapy (e.g., implantable devices), but with notable
Citation: Carver C, Ahmed R.
Characteristics and prognosis of divergences in the use of immunosuppression and a preference for implantable
patients with cardiac sarcoidosis cardioverter defibrillators over permanent pacemakers. This narrative review aimed
presenting with atrioventricular to outline the clinical features of patients with CS presenting with AVB or VA and
block and ventricular arrhythmias.
Brain & Heart. 2024;2(4):3515. examine diagnostic investigations, imaging techniques, treatment approaches, and
doi: 10.36922/bh.3515 prognosis based on current research and international guidelines.
Received: April 27, 2024
Accepted: August 19, 2024 Keywords: Cardiac sarcoidosis; Sarcoidosis; Atrioventricular block; Ventricular tachycardia;
Ventricular fibrillation; Sudden cardiac death
Published Online: October 8, 2024
Copyright: © 2024 Author(s).
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution 1. Introduction
License, permitting distribution,
and reproduction in any medium, Sarcoidosis is a multisystem disease characterized by granuloma formation, inflammation,
provided the original work is and subsequent scarring. Cardiac involvement is clinically evident in approximately 5%
properly cited. of cases, although imaging and postmortem studies have revealed that this may be an
1,2
Publisher’s Note: AccScience underestimation. Cardiac sarcoidosis (CS) has a worse prognosis than other organ
Publishing remains neutral with involvement, contributing to death in up to 85% of Japanese patients with sarcoidosis.
2
regard to jurisdictional claims in
published maps and institutional The manifestations of CS vary and include atrioventricular block (AVB), ventricular
affiliations. arrhythmias (VAs), left ventricular systolic dysfunction, and even sudden cardiac death,
Volume 2 Issue 4 (2024) 1 doi: 10.36922/bh.3515