Cardiac implantable electronic device trends and infection risk in cardiac sarcoidosis: A 30-year perspective from southern and western Sweden

BACKGROUND: Cardiac sarcoidosis (CS) can cause arrhythmias and heart failure, often requiring cardiac implantable electronic devices (CIEDs). The 2014 Heart Rhythm Society consensus strengthened implantable cardioverter-defibrillator (ICD) recommendations in CS, potentially affecting practice patterns. Immunosuppressive therapy, central to CS management, may increase CIED infection risk. OBJECTIVE: To evaluate 30-year trends in CIED use in CS and the association between immunosuppression timing and 1-year infection risk. METHODS: This retrospective cohort study included patients with CS who received a CIED at 2 Swedish tertiary centers between 1994 and 2023. Device type and indications were compared before and after the 2014 Heart Rhythm Society consensus (1994-2014 vs 2015-2023). CIED infection rates were analyzed according to immunosuppression initiation (>10 days after implantation vs within or before 10 days). RESULTS: Among 212 patients diagnosed with CS, 140 (66.0%) received a CIED and were included in this study. ICDs were the first implanted device in 70.7% of patients, increasing from 66.0% to 73.6% before and after 2014, respectively, and 59.7% were for primary prevention. The mean interval from CS diagnosis to CIED implantation significantly shortened after 2014 (-1.5 vs 0.1 years, P = .037), suggesting earlier diagnosis relative to CIED implantation. The overall CIED infection rate was 6.4% (n = 9), 7.5% in patients with delayed and 5% in those with early-initiated immunosuppression. CONCLUSION: In CS, early recognition and ICD utilization, particularly for primary prevention, have increased. CIED infection rates were similar regardless of the timing of immunosuppression initiation relative to CIED implantation.