Key result
Cardiac sarcoidosis can predominantly involve the left atrium and manifest solely as atrial arrhythmia.
Why the study?
Cardiac sarcoidosis predominantly involves the left ventricle and septum but rarely the atrial wall, and atrial arrhythmia as a sole manifestation may be underdiagnosed.
Case Report (n=1)
Cardiac sarcoidosis can rarely present with predominant left atrial involvement and atrial arrhythmias, highlighting the importance of multimodality imaging for diagnosis.
May present as isolated left atrial re-entrant tachycardia; case report leaves open whether multimodality imaging should be pursued in unexplained atrial arrhythmias.
A 61-year old woman was admitted to our hospital due to recurrent episodes of palpitation and exertional dyspnoea. Electrocardiogram showed paroxysmal atrial tachycardia. The electrophysiological study disclosed intraatrial re-entrant tachycardia of left atrial origin. A transoesophageal echocardiogram revealed a diffuse thickening of the left atrial wall with a maximal thickness of 4 mm (Panel A, arrowheads). Left ventricular function was preserved. Cardiac magnetic resonance imaging exhibited diffuse thickening and late gadolinium enhancement in the left atrial epicardial wall as well as left atrial dilatation (Panel B). A fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) showed diffuse FDG uptake in the left atrial wall, corresponding the thickened area on echocardiography and cardiac magnetic resonance (Panel C). Focal FDG uptake was also noted in the left ventricular lateral and septal wall. Mediastinal lymph node biopsy revealed non-caseating granulomas, indicating sarcoidosis (Panel D). Based on these non-invasive images and histological findings, the patient was diagnosed as cardiac sarcoidosis with predominant involvement of the left atrium and left atrial re-entrant tachycardia. Cardiac sarcoidosis predominantly involves the left ventricle and interventricular septum, but rarely atrial wall. Post-mortem studies reported atrial involvement ranging from 6% to 12% in patients with cardiac sarcoidosis. Atrial arrhythmia may emerge as a sole cardiac manifestation of this disease and be underdiagnosed. Cardiac sarcoidosis is an important differential diagnosis to consider when diffuse thickening of the left atrium is noted.
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Enzan et al. (2019) conducted a case report in Cardiac sarcoidosis (n=1). Cardiac sarcoidosis was evaluated. Cardiac sarcoidosis can predominantly involve the left atrium and manifest solely as atrial arrhythmia, as demonstrated in a 61-year-old woman with left atrial re-entrant tachycardia.
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