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Prospective Study of Cardiac Sarcoid Mimicking Arrhythmogenic Right Ventricular Dysplasia
Author(s) -
VASAIWALA SMIT C.,
FINN CYNTHIA,
DELPRIORE JEANNE,
LEYA FRED,
GAGERMEIER JAMES,
AKAR JOSEPH G.,
SANTUCCI PETER,
DAJANI KHALED,
BOVA DAVIDE,
PICKEN MARIA M.,
BASSO CRISTINA,
MARCUS FRANK,
WILBER DAVID J.
Publication year - 2009
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2008.01351.x
Subject(s) - medicine , arrhythmogenic right ventricular dysplasia , cardiology , ejection fraction , left bundle branch block , ventricle , cardiomyopathy , prospective cohort study , heart failure
Case studies indicate that cardiac sarcoid may mimic the clinical presentation of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C); however, the incidence and clinical predictors to diagnose cardiac sarcoid in patients who meet International Task Force criteria for ARVD/C are unknown.Methods and Results:Patients referred for evaluation of left bundle branch block (LBBB)‐type ventricular arrhythmia and suspected ARVD/C were prospectively evaluated by a standardized protocol including right ventricle (RV) cineangiography‐guided myocardial biopsy. Sixteen patients had definite ARVD/C and four had probable ARVD/C. Three patients were found to have noncaseating granulomas on biopsy consistent with sarcoid. Age, systemic symptoms, findings on chest X‐ray or magnetic resonance imaging (MRI), type of ventricular arrhythmia, RV function, ECG abnormalities, and the presence or duration of late potentials did not discriminate between sarcoid and ARVD/C. Left ventricular dysfunction (ejection fraction <50%) was present in 3/3 patients with cardiac sarcoid, but only 2/17 remaining patients with definite or probable ARVD/C (P = 0.01).Conclusions:In this prospective study of consecutive patients with suspected ARVD/C evaluated by a standard protocol including biopsy, the incidence of cardiac sarcoid was surprisingly high (15%). Clinical features, with the exception of left ventricular dysfunction and histological findings, did not discriminate between the two entities.