Related Experiment Video
Updated: Jan 22, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Electrophysiologic testing for diagnostic evaluation and risk stratification in patients with suspected cardiac
Matthew M Zipse1, Wendy S Tzou1, Joseph L Schuller1
1Division of Cardiology, Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado.
Insights
Electrophysiologic testing (EPS) helps stratify risk for ventricular arrhythmias (VAs) in cardiac sarcoidosis (CS) patients with normal heart function. A positive EPS indicates higher VA risk, but ongoing monitoring is crucial for all patients.
Area of Science:
- Cardiology
- Electrophysiology
- Sarcoidosis Research
Background:
- Cardiac sarcoidosis (CS) poses a risk for ventricular arrhythmias (VAs) and sudden cardiac death (SCD).
- Risk stratification in CS patients with preserved left ventricular/right ventricular (LV/RV) systolic function is challenging.
- Electrophysiologic testing and programmed electrical stimulation of the ventricle (EPS) may aid risk assessment.
Purpose of the Study:
- To evaluate the utility of EPS in patients with suspected CS and preserved ventricular function.
- To determine if EPS can effectively stratify the risk of VAs and SCD in this patient population.
Main Methods:
- One hundred twenty consecutive patients with biopsy-proven extracardiac sarcoidosis and preserved LV/RV systolic function underwent EPS.
- Patients were classified as probable or possible CS based on imaging and clinical factors.
- Follow-up for SCD and VAs was conducted over 4.5 ± 2.6 years.
Main Results:
- Seven patients (6%) with positive EPS had inducible ventricular tachycardia (VT) and received an implantable cardioverter defibrillator (ICD).
- Positive EPS was associated with subsequent ICD therapies for VAs (43% of those with positive EPS).
- Kaplan-Meier analysis showed a significant difference in freedom from VAs and SCD stratified by EPS, primarily in the probable CS subgroup.
Conclusions:
- EPS is valuable for risk stratification in probable CS patients with preserved LV/RV function, with positive results correlating to VAs.
- A negative EPS suggests low risk, but close follow-up is essential due to the potential for disease progression.
- EPS cannot predict all fatal VAs, especially those related to new cardiac involvement or disease advancement.
Introduction:
While cardiac sarcoidosis (CS) carries a risk of ventricular arrhythmias (VAs) and sudden cardiac death (SCD), risk stratification of patients with CS and preserved left ventricular/right ventricular (LV/RV) systolic function remains challenging. We sought to evaluate the role of electrophysiologic testing and programmed electrical stimulation of the ventricle (EPS) in patients with suspected CS with preserved ventricular function.
Methods:
One hundred twenty consecutive patients with biopsy-proven extracardiac sarcoidosis and preserved LV/RV systolic function underwent EPS. All patients had either probable CS defined by an abnormal cardiac positron emission tomography or cardiac magnetic resonance imaging, or possible CS with normal advanced imaging but abnormal echocardiogram (ECG), SAECG, Holter, or clinical factors. Patients were followed for 4.5 ± 2.6 years for SCD and VAs.
Results:
Seven of 120 patients (6%) had inducible ventricular tachycardia (VT) with EPS and received an implantable cardioverter defibrillator (ICD). Three patients (43%) with positive EPS later had ICD therapies for VAs. Kaplan-Meier analysis stratified by EPS demonstrated a significant difference in freedom from VAs and SCD (P = 0.009), though this finding was driven entirely by patients within the cohort with probable CS (P = 0.018, n = 69). One patient with possible CS and negative EPS had unrecognized progression of the disease and unexplained death with evidence of CS at autopsy.
Conclusions:
EPS is useful in the risk stratification of patients with probable CS with preserved LV and RV function. A positive EPS was associated with VAs. While a negative EPS appeared to confer low risk, close follow-up is needed as EPS cannot predict fatal VAs related to new cardiac involvement or disease progression.
More Related Videos
Related Concept Videos
01:15Myasthenia Gravis: Diagnostic Tests
The edrophonium test is a diagnostic tool for myasthenia gravis. It involves...
01:19Electrophysiology of Normal Cardiac Rhythm
01:27Myocarditis II: Clinical Features and Diagnostic Tests
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:19Pericarditis II: Clinical Features and Diagnostic Tests
01:24Cardiac Catheterization III: Left Heart Catheterization