Role of radiofrequency catheter ablation of ventricular tachycardia in cardiac sarcoidosis: report from a multicenter registry

Abstract

Background: Management of ventricular tachycardia (VT) is challenging in patients with cardiac sarcoidosis.

Objective: The purpose of this study was to assess the response of VT in patients with cardiac sarcoidosis to medical therapy and radiofrequency ablation.

Methods: Forty-two patients with a diagnosis of cardiac sarcoidosis based on the Japanese Health Ministry criteria were followed. When VT occurred, a stepwise approach was used: implantable cardioverter-defibrillator placement, immunosuppressive agents, antiarrhythmic medications, then radiofrequency ablation.

Results: In nine patients (age 46.7 +/- 8.6 years; ejection fraction 42 +/- 14%), VT was not controlled by medical therapy, and radiofrequency ablation was performed. A total of 44 VTs (mean cycle length 348 +/- 78 ms) were induced. Endocardial radiofrequency ablation was performed in eight patients (right ventricular in 5, left ventricular in 3) and epicardial radiofrequency ablation in one patient. In 4 of 5 patients with right ventricular VTs, a peritricuspid circuit was identified. Critical areas were identified for 21 (48%) of 44 VTs, resulting in elimination of 31 (70%) of 44 VTs. The most frequent VT circuit was reentry in the peritricuspid area. This type of VT was eliminated in all patients. Arrhythmic events decreased from 271 +/- 363 episodes preablation to 4.0 +/- 9.7 postablation. All patients had either a decrease (n = 4) or complete elimination (n = 5) of VT during mean follow-up of 19.8 +/- 19.6 months.

Conclusion: Catheter ablation of VT in patients with cardiac sarcoidosis refractory to medical therapy is effective in eliminating VT or markedly reducing the VT burden. The disease process in cardiac sarcoidosis often involves a specific area in the basal right ventricle predisposing to peritricuspid reentry.