Key result
In a 67-year-old man presenting with right ventricular outflow tract ventricular tachycardia, cardiac MRI and PET-CT confirmed isolated cardiac sarcoidosis, which was successfully managed with steroids and an ICD.
Case Report (n=1)
No
Infiltrative disorders such as cardiac sarcoidosis should be considered in patients with prior CAD presenting with VT that has an apparent right ventricular focus on ECG.
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May warrant sarcoidosis evaluation in unexplained VT; leaves open optimal management strategies for isolated cardiac disease.
A 67-year-old man with coronary artery disease (CAD) and left anterior descending artery (LAD) stent presented with symptomatic monomorphic ventricular tachycardia (VT) at a rate of 190 bpm requiring cardioversion. ECG showed left bundle branch block pattern and inferior axis, suggestive of a right ventricular outflow tract (RVOT) focus rather than left ventricular scar due to LAD territory myocardial infarction (MI). Echocardiography showed normal wall motion. Angiography revealed a patent mid-LAD stent. Cardiac MRI with delayed postcontrast sequence revealed several regions of hyperenhancement abnormality within the basal portion of the interventricular septum. Increased metabolic activity on positron emission tomography confirmed active inflammatory sarcoidosis.Although VTs in patients with prior CAD are likely to be related to either scar or ischaemia, alternative diagnoses (eg, infiltrative disorders, RVOT-VT, arrhythmogenic right ventricular cardiomyopathy) should be considered in patients with an apparent right ventricular focus on ECG.
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Atreya et al. (2017) conducted a case report in Cardiac sarcoidosis (n=1). Steroid therapy and ICD implantation was evaluated on Recurrence of ventricular arrhythmia. In a 67-year-old man presenting with right ventricular outflow tract ventricular tachycardia, cardiac MRI and PET-CT confirmed isolated cardiac sarcoidosis, which was successfully managed with steroids and an ICD.
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