The role of implantable cardiac defibrillators in cardiac sarcoidosis: saviour or sinner?

This editorial refers to ‘Efficacy and safety of implantable cardiac defibrillators for treatment of ventricular arrhythmias in patients with cardiac sarcoidosis’ by J. Kron et al. , on page 347 Sarcoidosis has been described as an enigmatic disease and shows significant heterogeneity in pattern, severity, and clinical course, with substantial geographical variations. For the majority affected, it carries a benign course, typically confined to the lungs and requiring no treatment.1 The same cannot be said when sarcoidosis involves the heart. Cardiac involvement in sarcoidosis manifests clinically in ∼5% of patients, although autopsy studies have estimated cardiac involvement at closer to 30%.2 Progressive heart failure and malignant cardiac arrhythmias account for up to 77% of deaths due to sarcoidosis.3 Although there are no randomized studies evaluating the role of implantable cardiac defibrillators (ICDs) in cardiac sarcoidosis (CS), ICD implantation for CS carries a Class IIa recommendation in published guidelines.4In this issue of the Journal , Kron et al. 5 report on the largest retrospective series of patients with CS …