title: Bidirectional ventricular tachycardia in cardiac sarcoidosis.
abstract: A 73-year-old man with history of pulmonary sarcoidosis was found to have runs of non-sustained bidirectional ventricular tachycardia (BVT) with two different QRS morphologies on a Holter monitor. Cardiac magnetic resonance delayed gadolinium imaging revealed a region of patchy mid-myocardial enhancement within the left ventricular basal inferolateral myocardium. An 18-fluorodeoxyglucose positron emission tomography (FDG-PET) showed increased uptake in the same area, consistent with active sarcoid, with no septal involvement. Follow-up FDG-PET one year later showed disease progression with new septal involvement. Cardiac sarcoidosis, characterized by myocardial inflammation and interstitial fibrosis that can lead to conduction system disturbance and macro re-entrant arrhythmias, should be considered in differential diagnosis of BVT. BVT may indicate septal involvement with sarcoidosis before the lesions are large enough to be detected radiologically.
authors.affiliation: Department of Internal Medicine (Division of Cardiology), University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53713, United States.
authors.forename: Mina M
authors.initials: MM
authors.lastname: Benjamin
authors.affiliation: Department of Internal Medicine (Division of Cardiology), University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53713, United States.
authors.forename: Kevin
authors.initials: K
authors.lastname: Hayes
authors.affiliation: Department of Internal Medicine (Division of Cardiology), University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53713, United States.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Field
authors.affiliation: Department of Internal Medicine (Division of Cardiology), University of California in San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, United States.
authors.forename: Melvin M
authors.initials: MM
authors.lastname: Scheinman
authors.affiliation: Department of Internal Medicine (Division of Cardiology), University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53713, United States.
authors.forename: Kurt S
authors.initials: KS
authors.lastname: Hoffmayer
keywords: Arrhythmias; BVT, Bidirectional ventricular tachycardia; Cardiac sarcoidosis; ICD, Implantable cardioverter defibrillator; Magnetic resonance tomography; PET, Positron emission tomography; PVC, Premature ventricular contraction; Positron emission tomography; VT, Ventricular tachycardia.; Ventricular tachycardia