title: Efficacy and safety of implantable cardiac defibrillators for treatment of ventricular arrhythmias in patients with cardiac sarcoidosis.
abstract: OBJECTIVE
  Implantable cardiac defibrillator (ICD) implantation is a class IIA recommendation for patients with cardiac sarcoidosis (CS). However, little is known about the efficacy and safety of ICDs in this population. The goal of this multicentre retrospective data review was to evaluate the efficacy and safety of ICDs in patients with CS.
  
  
  RESULTS
  Electrophysiologists at academic medical centres were asked to identify consecutive patients with CS and an ICD. Clinical information, ICD therapy history, and device complications were collected for each patient. Data were collected on 235 patients from 13 institutions, 64.7% male with mean age 55.6 ± 11.1. Over a mean follow-up of 4.2 ± 4.0 years, 85 of 234 (36.2%) patients received an appropriate ICD therapy (shocks and/or anti-tachycardia pacing) and 67 of 226 (29.7%) received an appropriate shock. Fifty-seven of 235 patients (24.3%) received a total of 222 inappropriate shocks. Forty-six adverse events occurred in 41 of 235 patients (17.4%). Patients who received appropriate ICD therapies were more likely to be male (73.8 vs. 59.6%, P = 0.0330), have a history of syncope (40.5 vs. 22.5%, P = 0.0044), lower left ventricular ejection fraction (38.1 ± 15.2 vs. 48.8 ± 14.7%, P ≤ 0.0001), ventricular pacing on baseline electrocardiogram (16.1 vs. 2.1%, P = 0.0002), and a secondary prevention indication (60.7 vs. 24.5%, P < 0.0001) compared with those who did not receive appropriate ICD therapies.
  
  
  CONCLUSIONS
  Patients with CS and ICDs are at high risk for ventricular arrhythmias. This population also has high rates of inappropriate shocks and device complications.
authors.affiliation: Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, VA, USA. jkron@mcvh-vcu.edu
authors.forename: Jordana
authors.initials: J
authors.lastname: Kron
authors.forename: William
authors.initials: W
authors.lastname: Sauer
authors.forename: Joseph
authors.initials: J
authors.lastname: Schuller
authors.forename: Frank
authors.initials: F
authors.lastname: Bogun
authors.forename: Thomas
authors.initials: T
authors.lastname: Crawford
authors.forename: Sinan
authors.initials: S
authors.lastname: Sarsam
authors.forename: Lynda
authors.initials: L
authors.lastname: Rosenfeld
authors.forename: Teferi Y
authors.initials: TY
authors.lastname: Mitiku
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Cooper
authors.forename: Davendra
authors.initials: D
authors.lastname: Mehta
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Greenspon
authors.forename: Matthew
authors.initials: M
authors.lastname: Ortman
authors.forename: David B
authors.initials: DB
authors.lastname: Delurgio
authors.forename: Ravinder
authors.initials: R
authors.lastname: Valadri
authors.forename: Calambur
authors.initials: C
authors.lastname: Narasimhan
authors.forename: Nalla
authors.initials: N
authors.lastname: Swapna
authors.forename: Jagmeet P
authors.initials: JP
authors.lastname: Singh
authors.forename: Stephan
authors.initials: S
authors.lastname: Danik
authors.forename: Steven M
authors.initials: SM
authors.lastname: Markowitz
authors.forename: Adrian K
authors.initials: AK
authors.lastname: Almquist
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Krahn
authors.forename: Luke G
authors.initials: LG
authors.lastname: Wolfe
authors.forename: Shawn
authors.initials: S
authors.lastname: Feinstein
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Ellenbogen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D009202:Cardiomyopathies / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012507:Sarcoidosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D055502:Secondary Prevention / Q000295:instrumentation* / Q000379:methods; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult