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Arrhythmias in Cardiac Sarcoidosis Bench to Bedside: A Case-Based Review.

ABSTRACT: Cardiac sarcoidosis is a component of an often multiorgan granulomatous disease of still uncertain cause. It is being recognized with increasing frequency, mainly as the result of heightened awareness and new diagnostic tests, specifically cardiac magnetic resonance imaging and ¹⁸F-fluorodeoxyglucose positron emission tomography scans. The purpose of this case-based review is to highlight the potentially life-saving importance of making the early diagnosis of cardiac sarcoidosis using these new tools and to provide a framework for the optimal care of patients with this disease. We will review disease mechanisms as currently understood, associated arrhythmias including conduction abnormalities, and atrial and ventricular tachyarrhythmias, guideline-directed diagnostic criteria, screening of patients with extracardiac sarcoidosis, and the use of pacemakers and defibrillators in this setting. Treatment options, including those related to heart failure, and those which may help clarify disease mechanisms are included.

SUBMITTER: Rosenfeld LE

PROVIDER: S-EPMC8142901 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Arrhythmias in Cardiac Sarcoidosis Bench to Bedside: A Case-Based Review.

Rosenfeld Lynda E LE Chung Mina K MK Harding Clifford V CV Spagnolo Paolo P Grunewald Johan J Appelbaum Jason J Sauer William H WH Culver Daniel A DA Joglar Jose A JA Lin Ben A BA Jellis Christine L CL Dickfeld Timm-Michael TM Kwon Deborah H DH Miller Edward J EJ Cremer Paul C PC Bogun Frank F Kron Jordana J Bock Ashley A Mehta Davendra D Leis Paul P Siontis Konstantinos C KC Kaufman Elizabeth S ES Crawford Thomas T Zimetbaum Peter P Zishiri Edwin T ET Singh Jagmeet P JP Ellenbogen Kenneth A KA Chrispin Jonathan J Quadri Syed S Vincent Logan L LL Patton Kristen K KK Kalbfleish Steven S Callahan Thomas D TD Murgatroyd Francis F Judson Marc A MA Birnie David D Okada David R DR Maulion Christopher C Bhat Pavan P Bellumkonda Lavanya L Blankstein Ron R Cheng Richard K RK Farr Maryjane A MA Estep Jerry D JD

Circulation. Arrhythmia and electrophysiology 20210216 2

Cardiac sarcoidosis is a component of an often multiorgan granulomatous disease of still uncertain cause. It is being recognized with increasing frequency, mainly as the result of heightened awareness and new diagnostic tests, specifically cardiac magnetic resonance imaging and <sup>18</sup>F-fluorodeoxyglucose positron emission tomography scans. The purpose of this case-based review is to highlight the potentially life-saving importance of making the early diagnosis of cardiac sarcoidosis using ...[more]

PMID: 33591816

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Project description:OBJECTIVES:Cardiac arrest etiology may be an important source of between-patient heterogeneity, but the impact of etiology on organ injury is unknown. We tested the hypothesis that asphyxial cardiac arrest results in greater neurologic injury than cardiac etiology cardiac arrest (ventricular fibrillation cardiac arrest), whereas ventricular fibrillation cardiac arrest results in greater cardiovascular dysfunction after return of spontaneous circulation. DESIGN:Prospective observational human and randomized animal study. SETTING:University laboratory and ICUs. PATIENTS:Five-hundred forty-three cardiac arrest patients admitted to ICU. SUBJECTS:Seventy-five male Sprague-Dawley rats. INTERVENTIONS:We examined neurologic and cardiovascular injury in Isoflurane-anesthetized rat cardiac arrest models matched by ischemic time. Hemodynamic and neurologic outcomes were assessed after 5 minutes no flow asphyxial cardiac arrest or ventricular fibrillation cardiac arrest. Comparison was made to injury patterns observed after human asphyxial cardiac arrest or ventricular fibrillation cardiac arrest. MEASUREMENTS AND MAIN RESULTS:In rats, cardiac output (20 ± 10 vs 45 ± 9 mL/min) and pH were lower and lactate higher (9.5 ± 1.0 vs 6.4 ± 1.3 mmol/L) after return of spontaneous circulation from ventricular fibrillation cardiac arrest versus asphyxial cardiac arrest (all p < 0.01). Asphyxial cardiac arrest resulted in greater early neurologic deficits, 7-day neuronal loss, and reduced freezing time (memory) after conditioned fear (all p < 0.05). Brain antioxidant reserves were more depleted following asphyxial cardiac arrest. In adjusted analyses, human ventricular fibrillation cardiac arrest was associated with greater cardiovascular injury based on peak troponin (7.8 ng/mL [0.8-57 ng/mL] vs 0.3 ng/mL [0.0-1.5 ng/mL]) and ejection fraction by echocardiography (20% vs 55%; all p < 0.0001), whereas asphyxial cardiac arrest was associated with worse early neurologic injury and poor functional outcome at hospital discharge (n = 46 [18%] vs 102 [44%]; p < 0.0001). Most ventricular fibrillation cardiac arrest deaths (54%) were the result of cardiovascular instability, whereas most asphyxial cardiac arrest deaths (75%) resulted from neurologic injury (p < 0.0001). CONCLUSIONS:In transcending rat and human studies, we find a consistent phenotype of heart and brain injury after cardiac arrest based on etiology: ventricular fibrillation cardiac arrest produces worse cardiovascular dysfunction, whereas asphyxial cardiac arrest produces worsened neurologic injury associated with greater oxidative stress.

Dataset Information

Arrhythmias in Cardiac Sarcoidosis Bench to Bedside: A Case-Based Review.

Publications

Arrhythmias in Cardiac Sarcoidosis Bench to Bedside: A Case-Based Review.

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