Key result
Multimodality imaging and electrophysiologic mapping identified atrial sarcoidosis as the cause of severe sinus node dysfunction and atrial flutter, leading to successful treatment with immunosuppression and a dual-chamber defibrillator.
Case Report (n=1)
This case highlights the rare presentation of cardiac sarcoidosis as severe sinus node dysfunction and atrial flutter, emphasizing the role of multimodality imaging in diagnosis and guiding appropriate device and medical therapy.
May support evaluation for atrial sarcoidosis in refractory sinus node dysfunction with flutter; leaves open prospective validation of multimodality imaging and immunosuppression.
Sarcoidosis is a multisystem disorder of unknown etiology characterized by noncaseating granuloma formation in pulmonary tissue and extrapulmonary organs, such as the skin, the lymph nodes, and the heart.1 Imaging studies have found asymptomatic cardiac involvement in 4% to 55% of patients and symptomatic involvement in 5% of patients with extracardiac sarcoidosis.2 Owing to heterogeneous involvement of the myocardium, cardiac disease manifestations are highly dependent on the location of inflammation and subsequent scar formation.
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Bhaskaran et al. (2018) conducted a case report in Atrial sarcoidosis with sinus arrest and reentrant right atrial flutter (n=1). Immunosuppression and dual-chamber defibrillator was evaluated on Clinical response and arrhythmia management. Multimodality imaging and electrophysiologic mapping identified atrial sarcoidosis as the cause of severe sinus node dysfunction and atrial flutter, leading to successful treatment with immunosuppression and a dual-chamber defibrillator.
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