Arrhythmic prognosis according to left ventricular systolic dysfunction severity in cardiac sarcoidosis

Area of Science:

• Cardiology
• Electrophysiology
• Sarcoidosis Research

Background:

• Current guidelines offer varied recommendations for implantable cardioverter-defibrillator (ICD) use in cardiac sarcoidosis (CS) patients with left ventricular ejection fraction (LVEF) <50%.
• This highlights a need for clearer risk stratification in this patient population.

Purpose of the Study:

• To investigate the risk of ventricular arrhythmias in CS patients who received an ICD.
• To compare this risk based on different degrees of left ventricular systolic dysfunction (LVEF ≤35% vs. 36%-49%) and ICD indication (primary vs. secondary prevention).

Main Methods:

• The study analyzed 61 CS patients with an ICD and LVEF <50% at initial evaluation.
• Primary outcome was survival free of sustained ventricular tachycardia (VT)/ventricular fibrillation (VF) post-ICD implantation.
• Comparative analysis was performed for LVEF groups and primary vs. secondary prevention indications.

Main Results:

• No significant difference in VT/VF risk was found between LVEF ≤35% and 36%-49% groups in univariable analysis.
• Secondary prevention ICD indication was the sole significant predictor of incident sustained VT/VF in multivariable analysis (HR 2.86, P=.015).
• Patients receiving ICDs for secondary prevention had a higher VT/VF event burden (0.47 events/patient-year) compared to primary prevention (0.11 events/patient-year).

Conclusions:

• Cardiac sarcoidosis patients with LVEF 36%-49% exhibit a similar high arrhythmic risk as those with LVEF ≤35%.
• Patients receiving ICDs for secondary prevention demonstrate the highest overall risk for ventricular arrhythmias.
• These findings suggest a need to reconsider current guidelines for ICD implantation in CS patients with varying LVEF.