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Catheter ablation of atrial arrhythmias in cardiac sarcoidosis
Jonathan M Willner1, Juan F Viles-Gonzalez2, James O Coffey2
1Divisions of Cardiology and Pulmonary Medicine, Mount Sinai Medical Center and Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Insights
Catheter ablation effectively manages atrial arrhythmias (AA) in cardiac sarcoidosis (CS) patients, with most achieving sustained sinus rhythm. This procedure offers a safe treatment option for symptomatic AA in this population.
Area of Science:
- Cardiology
- Electrophysiology
- Immunology
Background:
- Cardiac sarcoidosis (CS) is associated with supraventricular arrhythmias.
- The efficacy of catheter ablation for atrial arrhythmias (AA) in CS patients remains unclear.
Purpose of the Study:
- To investigate the role and outcomes of catheter ablation for managing symptomatic atrial arrhythmias in patients with cardiac sarcoidosis.
Main Methods:
- A cohort of 100 cardiac sarcoidosis patients was monitored for arrhythmias.
- Patients with persistent, symptomatic arrhythmias underwent catheter ablation.
- Post-ablation follow-up included Holter monitoring and device interrogation.
Main Results:
- 32% of CS patients experienced symptomatic supraventricular arrhythmias.
- Nine patients (28% of those with symptomatic arrhythmias) underwent catheter ablation for AA.
- Common arrhythmias included atrial fibrillation and atrial flutter, often left atrial in origin. Recurrence was low (2/9 patients).
Conclusions:
- Atrial arrhythmias in cardiac sarcoidosis are frequently left atrial.
- Catheter ablation demonstrates safety and efficacy in maintaining sinus rhythm for CS patients with AA.
Background:
We previously reported on the incidence and clinical implications of supraventricular arrhythmia in patients with cardiac sarcoidosis (CS). The role of catheter ablation for the management of atrial arrhythmia (AA) in this patient population is unknown.
Methods And Results:
One hundred consecutive patients with CS were monitored for the incidence of supraventricular arrhythmias. Those with persistent symptoms despite optimal medical therapy proceeded to catheter ablation. Following ablation, all patients were followed serially with Holter monitoring or device interrogation. Thirty-two (32%) patients had symptomatic supraventricular arrhythmias. Nine (28%) patients had symptomatic AA requiring catheter ablation for clinical indications. Mean age was 55 ± 11.6 years. Five (56%) patients had atrial fibrillation (AF), of whom 2 also had cavotricuspid isthmus ablation. Four patients had isolated atrial flutter: 2 patients with left atrial flutter, and 2 patients with cavotricuspid flutter. All other arrhythmias were ablated in the left atrium. Mean duration of follow-up was 1.8 ± 1.9 years. One patient with atypical atrial flutter, and one patient with AF have had recurrence; the remaining patients remain in sinus rhythm.
Conclusions:
Our study suggests that AA in CS is frequently left atrial in origin. Catheter ablation appears to be effective and safe for the maintenance of sinus rhythm in patients with CS.
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