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Abstract
Management of ventricular tachycardia (VT) is challenging in patients with cardiac
sarcoidosis.
The purpose of this study was to assess the response of VT in patients with cardiac
sarcoidosis to medical therapy and radiofrequency ablation.
Forty-two patients with a diagnosis of cardiac sarcoidosis based on the Japanese Health
Ministry criteria were followed. When VT occurred, a stepwise approach was used: implantable
cardioverter-defibrillator placement, immunosuppressive agents, antiarrhythmic medications,
then radiofrequency ablation.
In nine patients (age 46.7 +/- 8.6 years; ejection fraction 42 +/- 14%), VT was not
controlled by medical therapy, and radiofrequency ablation was performed. A total
of 44 VTs (mean cycle length 348 +/- 78 ms) were induced. Endocardial radiofrequency
ablation was performed in eight patients (right ventricular in 5, left ventricular
in 3) and epicardial radiofrequency ablation in one patient. In 4 of 5 patients with
right ventricular VTs, a peritricuspid circuit was identified. Critical areas were
identified for 21 (48%) of 44 VTs, resulting in elimination of 31 (70%) of 44 VTs.
The most frequent VT circuit was reentry in the peritricuspid area. This type of VT
was eliminated in all patients. Arrhythmic events decreased from 271 +/- 363 episodes
preablation to 4.0 +/- 9.7 postablation. All patients had either a decrease (n = 4)
or complete elimination (n = 5) of VT during mean follow-up of 19.8 +/- 19.6 months.
Catheter ablation of VT in patients with cardiac sarcoidosis refractory to medical
therapy is effective in eliminating VT or markedly reducing the VT burden. The disease
process in cardiac sarcoidosis often involves a specific area in the basal right ventricle
predisposing to peritricuspid reentry.