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Clinical and Imaging Abnormalities Associated With Inducible Ventricular Arrhythmias During Electrophysiologic Study
Taylor Treacy1,2, Reginald Pereira1, Pranai Tandon1
1Division of Pulmonary, Critical Care, and Sleep Medicine Icahn School of Medicine at Mount Sinai Hospital New York NY USA.
Insights
Cardiac sarcoidosis patients with mild ejection fraction impairment face sudden death risk. Electrophysiologic study (EPS) identifies high-risk individuals, with imaging predicting positive results.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiovascular Imaging
Background:
- Cardiac sarcoidosis (CS) patients with mildly reduced ejection fraction are at high risk for sudden cardiac death.
- Risk stratification is crucial for guiding implantable cardioverter-defibrillator (ICD) decisions in this population.
- Electrophysiologic study (EPS) is explored as a tool for risk stratification.
Purpose of the Study:
- To evaluate the utility of EPS for risk stratification in patients with CS and mildly impaired left ventricular ejection fraction.
- To identify predictors of positive EPS results in this patient cohort.
Main Methods:
- Retrospective cohort study of 101 CS patients (age >18 years) meeting specific diagnostic criteria.
- Inclusion criteria included probable CS, characteristic late gadolinium enhancement on cardiac MRI, and LVEF ≥40%.
- Patients underwent EPS for risk stratification.
Main Results:
- 15 patients had EPS-positive studies, while 86 were EPS-negative.
- EPS positivity correlated with antiarrhythmic therapy and ventricular tachycardia detection on ECG/Holter.
- Transmural myocardial scarring and T2-weighted MRI edema were significantly associated with EPS positivity.
Conclusions:
- Transmural scarring and myocardial edema on cardiac MRI predict sustained ventricular arrhythmias during EPS in CS patients.
- Noninvasive imaging features show potential as prognostic indicators for sudden cardiac death risk.
- Further prospective studies are needed to refine ICD implantation guidelines for CS patients.
Background:
Patients with cardiac sarcoidosis (CS) and mildly impaired left ventricular ejection fraction remain at high risk for sudden cardiac death. However, risk stratification for implantable cardioverter-defibrillator implantation in this group is needed. We aimed to determine if electrophysiologic study (EPS) may be used as a noninvasive alternative for sudden cardiac death risk stratification.
Methods:
In this retrospective cohort study, we analyzed patients with CS (aged >18 years) with highly probable or probable sarcoidosis according to the World Association of Sarcoidosis and Other Granulomatous Disorders Sarcoidosis Organ Assessment Instrument, with evidence of late gadolinium enhancement on cardiac magnetic resonance imaging in a pattern consistent with CS and left ventricular ejection fraction ≥40%, who underwent EPS.
Results:
We identified 101 patients with CS, 15 EPS positive and 86 EPS negative. A higher proportion of patients with an EPS-positive study was associated with antiarrhythmic therapy (P=0.005) and ventricular tachycardia on ECG or Holter monitoring (P<0.001). In multivariable analysis, transmural myocardial scarring (odds ratio, 3.78 [95% CI, 1.05-14]; P=0.041) and edema on T2-weighted cardiac magnetic resonance imaging (odds ratio, 4.75 [95% CI, 1.09-21.2]; P=0.036) were associated with higher odds of an EPS-positive study. There was no association between anatomic distribution of scar within left ventricular and right ventricular segments and inducibility on EPS.
Conclusions:
In patients with CS and mildly impaired left ventricular ejection fraction, we demonstrated that transmural myocardial scarring and edema on T2-weighted cardiac magnetic resonance imaging are associated with sustained ventricular arrhythmia during EPS, suggesting that noninvasive imaging features may be used as prognostic indicators in patients with CS. Larger, prospective studies are needed to inform implantable cardioverter-defibrillator implantation guidelines.
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