Author + information
- Received November 2, 1990
- Revision received April 2, 1991
- Accepted April 12, 1991
- Published online October 1, 1991.
- Stephen L. Winters, MD, FACC∗,
- Marc Cohen, MD, FACC,
- Steven Greenberg, MD, FACC,
- Bernardo Stein, MD,
- Jay Curwin, MD,
- Elena Pe, RN and
- J.Anthony Gomes, MD, FACC
- ↵∗Address for reprints: Stephen L. Winters, MD, Division of Cardiology, Box 1054, The Mount Sinai Medical Center, 1 Gustave L. Levy Place, New York, New York 10029.
The presentation, cardiac anatomy and utility of programmed ventricular stimulation in seven patients with sustained ventricular tachycardia associated with sarcoidosis are described. The mean patient age was 38 ± 8 years. Pulmonary involvement was apparent in three patients and no systemic manifestations of sarcoidosis were present in one patient. All patients had electrocardiographic abnormalities at rest and six had a left ventricular ejection fraction <45%. All seven patients had left ventricular wall motion abnormalities and five had mitral valve dysfunction.
Sustained ventricular tachycardia was easily induced in all patients. Spontaneous sustained ventricular tachycardia was not prevented with corticosteroid administration. Despite antiarrhythmic drug therapy, two patients had sudden cardiac death and an additional four had recurrence of ventricular tachycardia. Four patients had an automatic cardioverter-defibrillator implanted and received drug therapy: all four received appropriate shocks.
This report represents the largest descriptive series of consecutive patients with sustained ventricular tachycardia associated with sarcoidosis. Antiarrhythmic drug therapy of ventricular tachycardia in patients with sarcoidosis, even when guided with programmed ventricular stimulation, is associated with a high rate of arrhythmia recurrence or sudden death, or both. Thus, implantation of an automatic antitachycardia device (cardioverter-defibrillator) should be considered as primary therapy in such patients. Furthermore, sarcoidosis should be excluded, with Kveim skin testing if necessary, in any patient with sustained ventricular tachycardia of unknown origin.
- Received November 2, 1990.
- Revision received April 2, 1991.
- Accepted April 12, 1991.