Cardiac sarcoidosis: The role of steroid therapy in managing myocardial inflammation and arrhythmic risks

Cardiac sarcoidosis (CS) is a rare but serious manifestation of sarcoidosis that can lead to significant morbidity and mortality due to arrhythmias and heart failure. The inflammatory process in CS is characterized by the formation of non-caseating granulomas in the myocardium, which can disrupt normal cardiac function and conduction. Corticosteroids are the primary therapeutic agents used to manage CS, particularly during the acute inflammatory phase, as they help reduce inflammation and improve cardiac function. However, the long-term use of steroids poses risks, including opportunistic infections and metabolic complications. Advanced imaging techniques, such as cardiac magnetic resonance imaging and positron emission tomography, play a crucial role in diagnosing CS and assessing myocardial involvement. These imaging modalities also aid in risk stratification for arrhythmic events, guiding therapeutic decisions such as the initiation of steroid therapy and the potential placement of implantable cardioverter-defibrillators. This review synthesizes current evidence regarding the role of steroid therapy in managing CS and its implications for cardiac arrhythmias, emphasizing the need for individualized treatment strategies to optimize patient outcomes.