Updates from the 2024 ESC and AHA Scientific Statements on Cardiac Sarcoidosis

Updates from the 2024 ESC and AHA Scientific Statements on Cardiac Sarcoidosis

Guest: Leslie T. Cooper Jr., M.D.
Host: Kyle W. Klarich, M.D.

Cardiac sarcoidosis is a systemic, chronic inflammatory disorder characterized by non-caseating, epithelioid cell granulomas that may involve many tissues and organs. The Heart Rhythm Society criteria for diagnosis of cardiac sarcoidosis require a biopsy-proven diagnosis of extra-cardiac sarcoidosis. If extra-cardiac sarcoidosis is confirmed, CS is highly probable when there is evidence of the following: (a) rhythm abnormalities in either ECG or Holter monitoring such as advanced AVB (Mobitz type II second-degree or third-degree AVB), sustained VT, and (b) LV dysfunction on echocardiography or CMR (LVEF <40%) and/or compatible pattern on advanced imaging modalities (cardiac PET, CMR). EMB, sometimes with electrogram guidance to increase diagnostic yield, remains useful in indeterminant cases, including isolated cardiac involvement or suspected genetic etiology. Multidisciplinary teams consisting of respiratory physicians, rheumatologists, and cardiologists with expertise in sarcoidosis as well as other relevant subspecialties such as advanced cardiac imaging specialists (CMR and nuclear medicine) and electrophysiologists are needed to integrate immunosuppression with arrhythmia and heart failure management.

Topics Discussed:

• What percentage of patients with cardiac sarcoidosis have lung or thoracic lymph node involvement?
• Which of the following are associated with greater risk of heart failure or ventricular arrhythmias in definite or probable cardiac sarcoidosis:
• Which of the following medications may be added to guideline directed treatments for the initial management of acute and symptomatic cardiac sarcoidosis?

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