**9. Prognosis**

In a relatively long series, Tokuda et al. [33] compared behavior and course of the cardiac sarcoidosis, after ablation with ventricular tachycardia catheter in patients with sarcoidosis and patients with other types of dilated nonischemic cardiopathies; 23% of the patients with sarcoidosis had previous arrhythmic storm, and 31% had a previous ablation and had been refactored for management with two antiarrhythmics. More than 50% had received amiodarone or beta-blockers. Although they all shared similar mechanisms of arrhythmogenesis with other types of cardiopathies, the group of patients with sarcoidosis had a higher rate of recurrence of ventricular tachycardia. After ablation, survival, or rehospitalization

**119**

**Author details**

Jhan Carlos Altamar Castillo1

Barranquilla, Colombia

\* and Miguel Jose Tejeda Camargo2

1 Specialist in cardiovascular electrophysiology General Clinic of the North,

Foundation - Institute of Cardiology, Bogota, Colombia

\*Address all correspondence to: jcarlomed@gmail.com

provided the original work is properly cited.

2 Fellow of Cardiovascular Electrophysiology, University of La Sabana, Cardioinfantil

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Cardiac Sarcoidosis*

*DOI: http://dx.doi.org/10.5772/intechopen.85310*

other forms of nonischemic cardiopathy.

related to the recurrence of ventricular arrhythmias, was greater in patients with cardiac sarcoidosis. This shows that sarcoidosis has the worst prognosis among all *Cardiac Sarcoidosis DOI: http://dx.doi.org/10.5772/intechopen.85310*

*Sarcoidosis and Granulomatosis - Diagnosis and Management*

indication, even if the atrioventricular block is reverted transiently

The implantation of a device can be useful in patients with cardiac sarcoidosis with stimulation

Immunosuppression can be useful in patients with cardiac sarcoidosis with atrioventricular block

The implantation of a cardioverter can be useful in patients with cardiac sarcoidosis and an

The assessment of myocardial inflammation via fluorodeoxyglucose positron 18 emission tomography can be useful in patients with cardiac sarcoidosis with ventricular arrhythmias

Immunosuppression can be useful in patients with cardiac sarcoidosis with ventricular arrhythmias

Spontaneous sustained ventricular arrhythmias, including previous cardiac arrest I

Implantation of cardioverter can be considered in cardiac sarcoidosis independent from ventricular

Cardioverter implantation can be considered in patients with ejection fraction from 36 to 49% and/ or ejection fraction of the right ventricle below 40%, even with optimal medical management for cardiac failure and a period of immunosuppression (if there was active inflammation).

An electrophysiological study for the stratification of sudden death can be considered in patients with ejection fraction of the left ventricle >35% even with optimal medical management for cardiac

Cardiac magnetic resonance imaging can be considered for the stratification of sudden death risk. IIb

failure and a period of immunosuppression (if there was active inflammation).

Therapy via antiarrhythmic medications can be useful in patients with ventricular arrhythmias

Ablation with catheter can be useful in patients with cardiac sarcoidosis and ventricular

Ejection fraction of the left ventricle smaller or equal to 35% even with optimal medical management and a period of immunosuppression (if there was active inflammation)

arrhythmias refractory to immunosuppression and antiarrhythmic therapy

• Unexplained syncope or pre-syncope, if it is of arrhythmic etiology

IIa

IIa

IIa

IIa

IIa

IIa

IIa

I

IIa

IIb

IIb

**Management of conduction malfunctions**

second degree (Mobitz II) or third degree

**Management of ventricular arrhythmias**

and evidence of myocardial inflammation

refractory to immunosuppression therapy

**Indications for implantable cardioverter**

function in one or more of the following:

**Stratification of sudden death risk**

*Management of conduction malfunctions.*

• Indication of permanent pacemaker implantation

• Inducible sustained ventricular arrhythmias

indication of permanent implantation of a pacemaker

**118**

**9. Prognosis**

**Table 4.**

In a relatively long series, Tokuda et al. [33] compared behavior and course of the cardiac sarcoidosis, after ablation with ventricular tachycardia catheter in patients with sarcoidosis and patients with other types of dilated nonischemic cardiopathies; 23% of the patients with sarcoidosis had previous arrhythmic storm, and 31% had a previous ablation and had been refactored for management with two antiarrhythmics. More than 50% had received amiodarone or beta-blockers. Although they all shared similar mechanisms of arrhythmogenesis with other types of cardiopathies, the group of patients with sarcoidosis had a higher rate of recurrence of ventricular tachycardia. After ablation, survival, or rehospitalization

related to the recurrence of ventricular arrhythmias, was greater in patients with cardiac sarcoidosis. This shows that sarcoidosis has the worst prognosis among all other forms of nonischemic cardiopathy.
