What is the clinical evidence from this study?

Study design: Case Report. Population: Cardiac Sarcoidosis (n=1). Intervention: Systemic corticosteroids, antiarrhythmic therapy, and AICD implantation. Primary outcome: Left ventricular ejection fraction (LVEF).

What does this research mean for the field?

Cardiac magnetic resonance imaging with late gadolinium enhancement is a critical diagnostic tool for identifying cardiac sarcoidosis in patients presenting with unexplained ventricular tachycardia and severely reduced left ventricular function. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To highlight the challenges in diagnosing cardiac sarcoidosis and the importance of imaging modalities in management.

May 23, 2026Open Access

Clinically Proven Cardiac Sarcoidosis Presenting as Recurrent Ventricular Tachycardia With Severely Reduced Left Ventricular Function: A Case Report

Key Result

Early immunosuppressive therapy, heart failure management, and AICD implantation resulted in the absence of syncope and improved left ventricular ejection fraction from 15% to 25%.

Key Points

To highlight the challenges in diagnosing cardiac sarcoidosis and the importance of imaging modalities in management.
Descriptive case report of a 42-year-old male with recurrent VT and syncopal episodes.
Utilized electrocardiography, CMR with LGE, and echocardiography for diagnosis.
Initiated treatment with corticosteroids, antiarrhythmic therapy, anticoagulation, and heart failure therapy.
Electrocardiography revealed self-terminating VT, with one episode lasting five hours.
Ejection fraction was found to be 15%, indicating severe LV dysfunction.
Serum angiotensin-converting enzyme levels were elevated at 90 U/L, supporting the diagnosis.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

42-year-old man with no prior cardiac history presenting with recurrent palpitations, syncopal episodes, sustained ventricular tachycardia, and severe left ventricular dysfunction (LVEF 15%).

Intervention

Systemic corticosteroids (prednisolone 500 mg stat then 50 mg orally once daily), amiodarone 200 mg once daily, metoprolol 50 mg once daily, and single-chamber automated implantable cardioverter-defibrillator (AICD) implantation.

Outcome

Symptomatic improvement (absence of syncope or palpitation) and improvement in left ventricular ejection fraction (LVEF) on follow-up.

Early immunosuppressive therapy and multidisciplinary management, including ICD implantation, improved clinical outcomes and LVEF in a patient with cardiac sarcoidosis presenting with VT and severe LV dysfunction.

Limitations

Lack of histological confirmation via tissue biopsy

Abstract

Cardiac sarcoidosis is a rare but life-threatening manifestation of systemic sarcoidosis, frequently presenting with ventricular arrhythmias, heart block, or sudden cardiac death. It remains underdiagnosed owing to its diverse clinical presentation and rarity and the limitations of conventional diagnostic modalities. We report a case of a 42-year-old man with no prior cardiac history who presented with a three-day history of recurrent palpitations and three to four syncopal episodes. Electrocardiography during syncope demonstrated self-terminating ventricular tachycardia (VT), with one episode lasting five hours, requiring pharmacological cardioversion. Coronary angiography revealed entirely normal coronary arteries. Cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE) identified a non-ischemic, epicardial-to-mid-myocardial enhancement pattern involving the interventricular septum, inferior wall, and lateral wall, accompanied by mediastinal and hilar lymphadenopathy. Two-dimensional echocardiography revealed severe left ventricular (LV) dysfunction with an ejection fraction of 15%. Serum angiotensin-converting enzyme levels were markedly elevated at 90 U/L (reference: 12-66 U/L). The patient was commenced on systemic corticosteroids (prednisolone), antiarrhythmic therapy (amiodarone), anticoagulation, and guideline-directed heart failure therapy. This case underscores the diagnostic utility of CMR-LGE in identifying non-ischemic infiltrative cardiomyopathy and highlights the importance of considering cardiac sarcoidosis in patients presenting with unexplained VT and severely reduced LV function. Early immunosuppressive therapy and multidisciplinary management are pivotal in improving clinical outcomes.

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