title: Ventricular tachycardia in cardiac sarcoidosis: characterization of ventricular substrate and outcomes of catheter ablation.
abstract: BACKGROUND
  Cardiac sarcoid-related ventricular tachycardia (VT) is a rare disorder; the underlying substrate and response to ablation are poorly understood. We sought to examine the ventricular substrate and outcomes of catheter ablation in this population.
  
  
  RESULTS
  Of 435 patients with nonischemic cardiomyopathy referred for VT ablation, 21 patients (5%) had cardiac sarcoidosis. Multiple inducible VTs were observed with mechanism consistent with scar-mediated re-entry in all VTs. Voltage maps showed widespread and confluent right ventricular scarring. Left ventricular scarring was patchy with a predilection for the basal septum, anterior wall, and perivalvular regions. Epicardial right ventricular scar overlay and exceeded the region of corresponding endocardial scar. After ≥1 procedures, ablation abolished ≥1 inducible VT in 90% and eliminated VT storm in 78% of patients; however, multiple residual VTs remained inducible. Failure to abolish all inducible VTs was because of septal intramural circuits or extensive right ventricular scarring. Multiple procedure VT-free survival was 37% at 1 year, but VT control was achievable in the majority of patients with fewer antiarrhythmic drugs compared with preablation (2.1±0.8 versus 1.1±0.8; P<0.001).
  
  
  CONCLUSIONS
  Patients with cardiac sarcoidosis and VT exhibit ventricular substrate characterized by confluent right ventricular scarring and patchy left ventricular scarring capable of sustaining a large number of re-entrant circuits. Catheter ablation is effective in terminating VT storm and eliminating ≥1 inducible VT in the majority of patients, but recurrences are common. Ablation in conjunction with antiarrhythmic drugs can help palliate VT in this high-risk population.
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Chirag
authors.initials: C
authors.lastname: Barbhaiya
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nagashima
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Eue-Keun
authors.initials: EK
authors.lastname: Choi
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Laurence M
authors.initials: LM
authors.lastname: Epstein
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Roy M
authors.initials: RM
authors.lastname: John
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Maytin
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Albert
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Miller
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Koplan
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Michaud
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors.forename: Usha B
authors.initials: UB
authors.lastname: Tedrow
authors.affiliation: From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA. wstevenson@partners.org.
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
mesh_terms: D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000150:complications* / Q000175:diagnosis; D017115:Catheter Ablation / Q000009:adverse effects; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D019233:Retreatment; D012507:Sarcoidosis / Q000150:complications* / Q000175:diagnosis; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: arrhythmias, cardiac; catheter ablation; radiofrequency catheter ablation; tachycardia, ventricular