title: Electrocardiographic characteristics in patients with pulmonary sarcoidosis indicating cardiac involvement.
abstract: BACKGROUND
  Sarcoidosis is a multisystem granulomatous disease that can affect the heart. Early identification of cardiac sarcoidosis (CS) is critical because sudden death can be the initial presentation. We sought to evaluate the potential role of the ECG for identification of cardiac involvement in a cohort of patients with biopsy-proven pulmonary sarcoidosis.
  
  
  METHODS
  Our cohort consisted of referred patients with biopsy-proven pulmonary sarcoidosis who demonstrated symptoms consistent with cardiac involvement. The ECG characteristics collected were PR, QRS duration, QT interval, rate, bundle branch block (BBB), fragmented QRS (fQRS). QRS fragmentation was defined as 2 anatomically contiguous leads demonstrating RSR' patterns in the absence of BBB.
  
  
  RESULTS
  There were 112 subjects included in the cohort. Of the 52 subjects eventually diagnosed with CS, 39 had an ECG demonstrating fQRS while 21 of the 60 of non-CS patients had fQRS (75% vs 33.9%, P < 0.01). A RBBB or LBBB pattern were both more prevalent in the CS population (RBBB: 23.1% vs 6.7%, P = 0.016; LBBB: 3.8% vs 1.7%, P = 0.6). QRS duration remained significantly associated with CS after exclusion of those with BBB (93.5 +/- 10.6 vs 88 +/- 11 ms; P = 0.04). When fQRS and bundle branch block were combined, 90.4% of CS patient's ECGs contained at least one of the features, compared to 36.7% of noncardiac CS (P < 0.01).
  
  
  CONCLUSIONS
  The presence of fQRS or BBB pattern in patients with pulmonary sarcoidosis is associated with cardiac involvement and therefore should prompt further evaluation.
authors: Section of Cardiac Electrophysiology, University of Colorado, and Division of Cardiology, National Jewish Health, Denver, Colorado, USA.
authors: Joseph L
authors: JL
authors: Schuller
authors: Matthew D
authors: MD
authors: Olson
authors: Matthew M
authors: MM
authors: Zipse
authors: Preston M
authors: PM
authors: Schneider
authors: Ryan G
authors: RG
authors: Aleong
authors: Howard D
authors: HD
authors: Wienberger
authors: Paul D
authors: PD
authors: Varosy
authors: William H
authors: WH
authors: Sauer