Multimodality Diagnostic Approach in Cardiac Sarcoidosis: from ECG to Magnetic Resonance Imaging
S.A.M. Said*, S. Post, R. de Nooijer, R. Nijhuis, H.H.D. Idzerda, J.W. op den Akker, O. Kessels, N.R.L. Wagenaar, A. Agool, C.D. Heymans
Aim: To describe the non-invasive multi-imaging options in patients who develop ventricular, supraventricular arrhythmias and conduction defects as a manifestation of cardiac sarcoidosis (CS) with biopsy documented systemic sarcoidosis.
Method: We report four cases of patients with extra-cardiac sarcoidosis presented with different manifestations of CS.
Results: CS was presented by ventricular tachycardia, total AV block, paroxysmal atrial fibrillation, persistent atrial flutter, complete right bundle branch block and multifocal PVC’s. Moderate diastolic dysfunction (DD) was detected on echocardiography in one patient and mild DD in two patients. Systemic sarcoidosis was histologically and/or cytologically confirmed in all patients. No endomyocardial biopsy was performed. 18F-fluorodeoxyglucose positron emission tomography (FDG PET) was performed in three patients and cardiovascular magnetic resonance imaging (cMRI) was undertaken in 3. Merging of FDG PET with cMRI images revealed inflammatory activity at the sites of late gadolinium enhancement (LGE). All subjects were treated medically with a combination of prednisolone and methotrexate or azathioprine. A dual chamber implantable cardioverter-defibrillator (ICD) was implanted in three patients and the fourth received a dual chamber pacemaker. Transthoracic echocardiography findings of diastolic dysfunction were detected in one patient.
Conclusions: Non-invasive multi-imaging diagnostic approach is useful in patients with biopsy-proven extra-cardiac sarcoidosis who develop conduction disorder, supraventricular or ventricular tachyarrhythmias to confirm cardiac involvement and monitor treatment.
