Exploring the Intersection of Sarcoidosis and Cardiac Arrhythmias

Abstract

Sarcoidosis is a multi-organ granulomatous disease of uncertain origin, characterized by the formation of non-necrotizing granulomas in various organs, including the heart. Cardiac involvement in sarcoidosis is rare, with approximately 5% of sarcoidosis patients developing clinically apparent cardiac disease, which is associated with significant morbidity and mortality. Genetically predisposed individuals develop granuloma in myocardium musculature, leading to aberrant conduction of cardiac impulses and the development of various arrhythmias. Common arrhythmias range from atrial fibrillation to ventricular tachycardia and can lead to sudden cardiac death because of ventricular fibrillation. The diagnostic challenge results from high specificity but rather limited sensitivity of endomyocardial biopsy, which is the gold standard diagnostic test, making advanced imaging techniques, such as cardiac magnetic resonance imaging and fluorine-18 fluorodeoxyglucose positron emission tomography, crucial for early detection. Management involves a complex approach with immunosuppression, antiarrhythmic medications, and catheter ablation, often supplemented by implantable cardioverter-defibrillators to prevent sudden cardiac death. In cardiac sarcoidosis, ventricular arrhythmias are common and cause high mortality. Timely intervention and management are crucial for a better prognosis. The disease's growing prevalence requires further research on refining early detection techniques and developing efficient treatment strategies for these high-risk patients. This review focuses on the etiopathogenesis of arrhythmias in cardiac sarcoidosis, diagnosis, and effective management strategies.

Keywords

• Sarcoidosis
• Granulomatous disorder
• Cardiac arrhythmias
• Ventricular tachycardia
• atrial fibrillation
• AV block.

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