Electrophysiological characteristics of ventricular tachyarrhythmias in cardiac sarcoidosis versus arrhythmogenic right ventricular cardiomyopathy.
BACKGROUND
Recent evidence suggests that cardiac sarcoidosis (CS) and arrhythmogenic right ventricular cardiomyopathy (ARVC) can manifest very similarly.


OBJECTIVE
To investigate whether there are significant demographic and electrophysiological differences between patients with CS and ARVC.


METHODS
We prospectively compared patients with proven CS or ARVC who underwent radiofrequency catheter ablation of ventricular tachycardias by using 3-dimensional electroanatomical mapping. Furthermore, we evaluated whether the diagnostic criteria for ARVC would have excluded ARVC in patients with CS.


RESULTS
Eighteen patients (13 men; mean age 44.9 years) were included. All 18 patients had mild to moderately reduced right ventricular ejection fraction. Patients with cardiac sarcoidosis (n = 8) had a significantly lower mean left ventricular ejection fraction (35.6±19.3 vs 60.6±9.4; P = .002). Patients with CS had a significantly wider QRS (0.146 vs 0.110s; P = .004). Five of 8 (63%) patients with CS fulfilled the diagnostic ARVC criteria. Ventricular tachycardias (VTs) with a left bundle branch block pattern were documented in all but one patient (with CS). Programmed ventricular stimulation induced an average of 3.7 different monomorphic VTs in patients with CS vs 1.8 in patients with ARVC (P = .01). VT significantly more often originated in the apical region of the right ventricle in CS vs ARVC (P = .001), with no other predilection sites. Ablation success and other electrophysiological parameters were not different.


CONCLUSIONS
The current diagnostic ARVC guidelines do not reliably exclude patients with CS. Clinical and electrophysiological parameters that were characteristic of CS in our patients include reduced left ventricular ejection fraction, a significantly wider QRS, right-sided apical VT, and more inducible forms of monomorphic VT.
Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital of Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany. dirk.dechering@ukmuenster.de
Dirk G
DG
Dechering
Simon
S
Kochhäuser
Kristina
K
Wasmer
Stephan
S
Zellerhoff
Christian
C
Pott
Julia
J
Köbe
Tilmann
T
Spieker
Sebastiaan R D
SR
Piers
Alex
A
Bittner
Gerold
G
Mönnig
Günter
G
Breithardt
Thomas
T
Wichter
Katja
K
Zeppenfeld
Lars
L
Eckardt
D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D001707:Biopsy, Needle; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012507:Sarcoidosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome