Atrial Arrhythmias in Cardiac Sarcoidosis-Case Presentation and Systematic Review

Sarcoidosis is a rare idiopathic, multiorgan disease with clinical cardiac involvement in approximately 5% of cases. Diagnosis and management of cardiac sarcoidosis (CS) have mainly focused on impaired LV function, ventricular arrhythmias, and atrio-ventricular conduction disease. Atrial arrhythmias (AA) may be an under-recognized manifestation of sarcoidosis, and the purpose of the study was to perform a systematic review of the current literature, with an emphasis on the prevalence and management of AA in CS. AA occur as a result of direct infiltration of granulomatous disease in the atria or secondary to atrial myopathic changes from pulmonary or ventricular disease. Positron emission tomography (PET) is the modality of choice for surveillance of disease activity in the atria. AA occur frequently, in up to 40% in patients with CS, and may be associated with frequent hospitalization and reduction in quality of life. Moreover, AA may be the predominant cardiac manifestation, and there should be some consideration to include AA as part of future iterations of the diagnostic criteria for CS. Contemporary treatment involves a combination of immunosuppression, anti-arrhythmic therapy, and catheter ablation, but recurrence occurs more frequently than in patients with non-CS AA. Further systematic studies, likely in the form of multi-center observational cohort studies, are required to inform guidelines on the specific management of AA in CS.