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Case Reports
. 2022 Jan-Feb;22(1):47-50.
doi: 10.1016/j.ipej.2021.10.004. Epub 2021 Oct 18.

A case of cardiac sarcoidosis mimicking Brugada syndrome

Vickram Vignesh Rangaswamy  1 , Daljeet Kaur Saggu  2 , Sachin Yalagudri  1 , Narasimhan Calambur  1
Affiliations
Case Reports

A case of cardiac sarcoidosis mimicking Brugada syndrome

Vickram Vignesh Rangaswamy et al. Indian Pacing Electrophysiol J. 2022 Jan-Feb.

Abstract

A 17-year-old boy was admitted for management of ventricular fibrillation (VF) with intermittent Brugada pattern on ECG. On evaluation, cardiac MRI revealed myocardial scar and mediastinal lymphadenopathy. 18-Fluorodeoxyglucose positron emission tomography scan showed inflammation in the heart, lungs, and lymph nodes. He was diagnosed as a case of cardiac sarcoidosis (CS) and treated with steroids. However, there was a reactivation of cardiac inflammation and the development of a second VF storm. Following catheter ablation, the patient's arrhythmia improved. This report highlights the inflammation due to CS mimicking channelopathic features.

Keywords: Brugada phenocopy; Brugada syndrome; Cardiac sarcoidosis; Catheter ablation; Epicardial ablation; Inflammatory cardiomyopathy; Ventricular fibrillation storm.

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Conflict of interest statement

Declaration of competing interest None of the authors have any conflicts of interest.

Figures

Fig. 1
Fig. 1
a- Baseline ECG; b- 12 lead ECG showing type I Brugada pattern, inset showing 2 mm coved type ST elevation in lead V2; c- Follow-up ECG during VT-Storm, showing the progression of disease in the form of RBBB with underlying atrial fibrillation; d- Single strip ECG showing polymorphic VT induced by short-coupled PVC; e− Single strip ECG showing PVCs of more than one morphology (black arrows) and VF; f- Single strip ECG showing monomorphic VT. ECG-electrocardiograph, VT-ventricular tachycardia; RBBB- right bundle branch block; PVC- premature ventricular contraction; VF-ventricular fibrillation.
Fig. 2
Fig. 2
a- Late gadolinium-enhanced cardiac MRI showing scar (white arrows) on the left side of the interventricular septum and right ventricular free wall; b- Cardiac 18-PET-CT scan with 18-FDG showing multiple mediastinal and right supraclavicular lymph node uptake along with myocardial uptake at baseline; c- PET scan after three months of therapy showing resolution of lymph node. See text for details. MRI- Magnetic Resonance Imaging; PET CT- Positron Emission Tomography and Computed Tomography; 18-FDG- 18-fluorodeoxyglucose.
Fig. 3
Fig. 3
a- ECG showing RBBB with ST-elevation V1– V3 (type 1 Brugada pattern); b- ECG showing PVC (second beat) from RVOT; c- ECG showing good pace map for RVOT PVC; d- ECG post-ablation showing persistent RBBB but ST-elevation settled; e, f- 3-D CARTO guided voltage map (normal >1.5 mV, border zone 0.5–1.5 mV, scar <0.5 mV of right ventricle endocardial (e) and epicardial (f) anteroposterior view. The white arrow in figure e showing the earliest site for clinical PVC (orange dot). Blue dots-isolated late potentials (red arrow); Light orange dots-fractionated signals, Red dots-ablation sites. See text for details. RBBB-Right bundle branch block; PVC- premature ventricular contraction; RVOT-right ventricular outflow tract.
figs1
figs1
See this image and copyright information in PMC

References

    1. Lazzerini P.E., Capecchi P.L., Laghi-Pasini F., Boutjdir M. Autoimmune channelopathies as a novel mechanism in cardiac arrhythmias. Nat Rev Cardiol. 2017;14:521–535. - PubMed
    1. Terasaki F., Yoshinaga K. New guidelines for diagnosis of cardiac sarcoidosis in Japan. Ann Nucl Cardiol. 2017;3:42–45.
    1. Vasaiwala S.C., Finn C., Delpriore J., Leya F., Gagermeier J., Akar J.G., Santucci P., Dajani K., Bova D., Picken M.M., Basso C., Marcus F., Wilber D.J. Prospective study of cardiac sarcoid mimicking arrhythmogenic right ventricular dysplasia. J Cardiovasc Electrophysiol. 2009;20:473–476. - PubMed
    1. Benjamin M.M., Hayes K., Field M.E., Scheinman M.M., Hoffmayer K.S. Bidirectional ventricular tachycardia in cardiac sarcoidosis. J Arrhythm. 2017;33(1):69–72. - PMC - PubMed
    1. Frustaci A., Priori S.G., Pieroni M., et al. Cardiac histological substrate in patients with clinical phenotype of Brugada syndrome. Circulation. 2005;112:3680–3687. - PubMed

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