Original Article Systematic Treatment Approach to Ventricular Tachycardia in Cardiac Sarcoidosis Yoshihisa Naruse, MD; Yukio Sekiguchi, MD; Akihiko Nogami, MD; Hiroyuki Okada, MD; Yasuteru Yamauchi, MD; Takeshi Machino, MD; Kenji Kuroki, MD; Yoko Ito, MD; Hiro Yamasaki, MD; Miyako Igarashi, MD; Hiroshi Tada, MD; Junichi Nitta, MD; Dongzhu Xu, MD; Akira Sato, MD; Kazutaka Aonuma, MD Background—Fatal arrhythmia is commonly observed in cardiac sarcoidosis, but clinical effects of a systematic treatment approach are still uncertain. This study sought to describe both clinical and electrophysiological characteristics and outcomes of systematic treatment approach to ventricular tachycardia (VT) associated with cardiac sarcoidosis. Methods and Results—We enrolled 37 consecutive patients (11 men; age, 56±11 years) with a diagnosis of sustained VT associated with cardiac sarcoidosis. Clinical effects of a systematic treatment approach including medical therapy (both steroid and antiarrhythmic agents), in association with radiofrequency catheter ablation, were evaluated. All patients received antiarrhythmic agents, and 34 received steroid therapy. During a 39-month follow-up, 23 (62%) patients were free from any VT episodes with medical therapy. Multivariable Cox regression analyses revealed that the absence of gallium-67 myocardial uptake was an independent predictor for VT recurrence (hazard ratio, 7.51; 95% confidence interval, 1.65–34.26; P1 year. The ICD patients underwent device interrogation at each clinic visit every 6 months. A 24hour Holter recording was obtained in the patients without an ICD at approximately yearly intervals. Long-term success was defined as the lack of any recurrence of sustained VT and appropriate ICD therapy.

Statistical Analysis

Figure 1. The systematic treatment approach of ventricular tachycardia (VT) with cardiac sarcoidosis. AADs indicates antiarrhythmic drugs; Pt, patient; RF, radiofrequency; and VT, ventricular tachycardia.

Continuous variables are expressed as mean±SD. Because of the limited sample size, nonparametric Mann–Whitney U tests were used to test for statistically significant differences in continuous variables between the study groups. All categorical variables are presented as number and percent in each group and were compared by a χ2 analysis or Fisher exact test. Multivariable Cox proportional regression analysis was applied to explore any predictors of VT recurrences. Variables included in multivariable Cox proportional hazard models were those with P