What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiac sarcoidosis (n=25). Intervention: Positive electrophysiology study vs. Negative electrophysiology study. Primary outcome: Ventricular arrhythmia during follow up (p=<0.0001).

March 16, 2019Open Access

Electrophysiology study for risk stratification in patients with cardiac sarcoidosis and abnormal cardiac imaging

Q: What are the key findings of this study?

In patients with cardiac sarcoidosis and abnormal cardiac imaging, a positive electrophysiology study perfectly predicted future ventricular arrhythmias (100% PPV), while a negative study had a 93% NPV.

Key Result

In patients with cardiac sarcoidosis and abnormal cardiac imaging, a positive electrophysiology study perfectly predicted future ventricular arrhythmias (100% PPV), while a negative study had a 93% NPV.

Study Design

Type

Cohort (n=25)

Multicenter

Structured PICO

Does electrophysiology study predict ventricular arrhythmias in patients with cardiac sarcoidosis and abnormal cardiac imaging?

Population

25 patients with probable or definite cardiac sarcoidosis (CS) and abnormal cardiac imaging (late gadolinium enhancement on CMR or abnormal 18-flourodeoxyglucose uptake on PET) who underwent electrophysiology study (EPS). Mean age 50, 56% male.

Intervention

Electrophysiology study (EPS) for risk stratification

Comparator

null

Outcome

Ventricular arrhythmia (VA) during follow up, defined as sustained ventricular tachycardia, ventricular fibrillation, sudden cardiac death, or any appropriate device tachytherapyhard clinical

In patients with cardiac sarcoidosis and abnormal cardiac imaging, electrophysiology study provides strong prognostic value, with a negative study reliably predicting freedom from ventricular arrhythmias.

Main Result

Absolute Event Rate: 100% vs 6.7%

p-value: p=<0.0001

Limitations

Retrospective nature of the study design
Not all patients were followed in a uniform manner
Method of EMR query for VA events not independently validated
Referral bias
Small sample size

Abstract

BACKGROUND: Abnormalities on cardiac imaging (cardiac magnetic resonance imaging CMR or positron emission tomography PET), left ventricular ejection fraction (LVEF), and electrophysiology study (EPS) all predict ventricular arrhythmias (VA) in patients with cardiac sarcoidosis (CS). We sought to assess the utility of EPS in patients with CS and abnormal cardiac imaging, focusing on those with LVEF >35%. METHODS: We identified all patients treated at our institution from 2000 to 2017 who: 1.) had probable or definite CS; 2.) had either late gadolinium enhancement (LGE) on CMR or abnormal 18-flourodeoxyglucose (FDG) uptake on PET, and 3.) had undergone EPS. The primary endpoint was VA during follow up. RESULTS: Twenty five patients were included, of whom 10 (40%) had positive EPS. During a mean follow-up of 4.8 +/- 3.4 years, 11 (44%) patients had VA. The positive predictive value (PPV) of EPS for VA was 100% and the negative predictive value (NPV) of EPS for VA was 93%. Among 12 patients with LVEF >35% and no prior VA, the PPV of EPS for VA was 100% and the NPV of EPS for VA was 90%. CONCLUSION: EPS may help with risk stratification in patients with CS and abnormal imaging, especially those without conventional indications for ICD placement. Among patients with LVEF >35% and no history of prior VA, a negative EPS has good positive and negative predictive value for future VA events.

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