Acute arrhythmia or ventricular dysfunction - when is it sarcoid? Indian perspective

Background: Sarcoidosis is a granulomatous disease of unknown cause with multi-organ system involvement. It is important to keep a high index of suspicion to diagnose cardiac sarcoidosis in patients presenting with recent onset ventricular dysfunction and arrhythmias. Methods: We profile a series of our patients to show how different patients of cardiac sarcoid can present. Results: In the seven cases we reported, all patients had presented with arrhythmias and left ventricular (LV) dysfunction, a common theme which may help in identifying the patients with cardiac sarcoidosis. They were all investigated by magnetic resonance imaging (MRI), positron emission tomography (PET), Mantoux, computed tomography (CT) scan, and single photon emission CT, with an endomyocardial biopsy and a biopsy of any accessible lymph node. Treatment was with steroids, antituberculosis treatment (ATT) with automatic implanted cardioverter-defibrillators (AICDs), and pacemakers as per need. Conclusion: All patients with recent onset LV dysfunction, recent onset of unexplained tachy- or brady-arrhythmias with ventricular dysfunction, and ventricular arrhythmias of recent onset of unexplained origin should undergo an MRI. If the MRI raises a suspicion of sarcoidosis, then Mantoux, PET, CT scans, endomyocardial catheter biopsies, and biopsy from any other accessible site should be considered. Further therapy with ATT and steroids, AICD and pacemakers, and antiarrhythmics is based on the patient profile