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Isolated cardiac sarcoidosis masquerading as right ventricular outflow tract ventricular tachycardia

Auras R Atreya1, Mitkumar Patel1, Senthil K Sivalingam1

  • 1University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA.

BMJ Case Reports
|July 2, 2017
PubMed

Insights

In patients with coronary artery disease (CAD) and ventricular tachycardia (VT), an apparent right ventricular focus on ECG may indicate sarcoidosis, not just scar or ischemia. This highlights the importance of considering alternative diagnoses for VT.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Cardiovascular Imaging

Background:

  • Ventricular tachycardia (VT) in patients with coronary artery disease (CAD) is often attributed to myocardial scar or ischemia.
  • An electrocardiogram (ECG) pattern suggestive of a right ventricular outflow tract (RVOT) focus, rather than left ventricular scar, can occur in CAD patients.

Observation:

  • A 67-year-old man with CAD and a history of LAD stent presented with monomorphic VT.
  • ECG suggested a right ventricular outflow tract (RVOT) origin, atypical for LAD territory MI.
  • Cardiac MRI revealed septal abnormalities, and PET confirmed active sarcoidosis.

Findings:

  • Despite prior CAD and LAD stenting, the VT was not scar-related.
  • Positron emission tomography identified active inflammatory sarcoidosis as the cause of VT.
  • The VT focus was ultimately attributed to cardiac sarcoidosis, not CAD.

Implications:

  • This case underscores the importance of considering infiltrative disorders like sarcoidosis in the differential diagnosis of VT.
  • Apparent RVOT VT in patients with CAD warrants a comprehensive diagnostic workup beyond typical scar evaluation.
  • Early identification and management of cardiac sarcoidosis are crucial for preventing recurrent VT and improving patient outcomes.

Keywords:
arrhythmiaspacing and electrophysiologyradiology

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