Cardiac Sarcoidosis, Left Ventricular Impairment and Chronic Right Ventricular Pacing: Pacing or Pathology?
Homa Forotan1, Matthew K Rowe2, Dariusz Korczyk1
1Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia.
Insights
Cardiac sarcoidosis can mimic pacing-induced cardiomyopathy. Early diagnosis and immunosuppression improved cardiac function, avoiding device upgrades in two patients with atrioventricular block.
Area of Science:
- Cardiology
- Immunology
Background:
- Cardiac sarcoidosis (CS) is a rare condition often presenting as atrioventricular block, ventricular arrhythmias, or left ventricular (LV) dysfunction.
- Diagnosing CS can be difficult due to its varied clinical presentations.
Purpose of the Study:
- To highlight the diagnostic challenges of cardiac sarcoidosis.
- To present cases of misdiagnosed CS initially presenting as pacing-induced cardiomyopathy.
Main Methods:
- Two case reports of patients with atrioventricular block and subsequent LV dysfunction.
- Investigation for CS and response to immunosuppressive therapy.
Main Results:
- Patients initially diagnosed with pacing-induced cardiomyopathy showed improvement in LV function with immunosuppression.
- Cardiac resynchronisation therapy (CRT) was avoided due to improved cardiac function.
Conclusions:
- Emphasizes the importance of considering CS in patients with unexplained heart conditions.
- Reviews diagnostic approaches, imaging modalities, and current treatment strategies for CS.
Background:
Cardiac sarcoidosis (CS) is an uncommon and under-recognised disease which most frequently presents with atrioventricular (AV) block and may also present with ventricular arrhythmias and left ventricular (LV) systolic dysfunction. Because of its protean clinical manifestations, confirming a diagnosis of CS is often challenging.
Methods:
We report two cases where patients presented with atrioventricular (AV) block without evidence of underlying myocardial disease, underwent chronic dual-chamber pacing, and presented several years later with severe LV systolic dysfunction.
Results:
Both patients were referred for assessment of pacing-induced cardiomyopathy with a view to upgrading their device to cardiac resynchronisation therapy (CRT). Subsequent investigation revealed features consistent with CS and appropriate immunosuppressive therapy resulted in improvement in LV function avoiding the requirement for CRT.
Conclusion:
We present a review of the diagnosis of cardiac sarcoidosis, the importance of imaging modalities and current treatment recommendations.
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