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The role of ICDs in patients with sarcoidosis-A comprehensive review
Sebastian Mactaggart1, Raheel Ahmed2
1Northumbria Healthcare NHS Foundation Trust, Newcastle, United Kingdom.
Insights
Implantable cardioverter defibrillators (ICDs) help prevent sudden cardiac death (SCD) in cardiac sarcoidosis (CS). Current guidelines may need revision, as even patients with normal ejection fraction are at high risk for ventricular arrhythmias.
Area of Science:
- Cardiology
- Electrophysiology
- Sarcoidosis Research
Background:
- Cardiac sarcoidosis (CS) poses a risk for sudden cardiac death (SCD).
- Implantable cardioverter defibrillators (ICDs) are used for SCD prevention in CS.
- Factors influencing outcomes in CS patients with ICDs are not well understood.
Purpose of the Study:
- To review outcomes in cardiac sarcoidosis patients with ICDs.
- To identify determinants of poor outcomes in this patient cohort.
Main Methods:
- Analysis of studies referencing 2014 HRS Consensus, 2017 AHA/ACC/HRS Guideline, and 2022 ESC Guidelines.
- Review of cardiac sarcoidosis patients with ICDs.
Main Results:
- Higher incidences of ventricular arrhythmia (VA) were observed in patients with Class I guideline recommendations compared to Class II.
- Patients with CS and normal left ventricular ejection fraction (LVEF) remain at high risk for VA and SCD.
Conclusions:
- Cardiac imaging is crucial for sarcoidosis patients.
- Current guidelines may require revision based on new evidence.
- Demographics and ventricular characteristics could aid in predicting ICD benefit.
Background:
Implantable cardioverter defibrillator (ICD) use in cardiac sarcoidosis (CS) to prevent sudden cardiac death (SCD) is a potentially life-saving intervention. However, the factors that determine outcome in this cohort remains largely unknown. This review analyses CS patients with an ICD and highlights determinants of poor outcome.
Outcomes:
Analysis of studies which used the 2014 HRS Consensus, 2017 AHA/ACC/HRS Guideline and 2022 ESC Guidelines showed that those with class I recommendations have higher incidences of ventricular arrhythmia (VA) than those with class II recommendations. Additionally, even those with normal left ventricular ejection fraction (LVEF) and CS are at high risk of VA and SCD.
Summary:
Compounding research emphasises the importance of cardiac imaging in those with sarcoidosis, with evidence to suggest a possible need for revision of the guidelines. Other variables such as demographics and ventricular characteristics may prove useful in predicting those to benefit most from ICD insertion.
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