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Boczar KE, Park Y, Wiefels C. Can FDG-PET Imaging Identify Cardiac Sarcoidosis Disease Phenotypes? Curr Cardiol Rep 2024:10.1007/s11886-024-02086-7. [PMID: 38990493 DOI: 10.1007/s11886-024-02086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE OF REVIEW Despite the scarcity of data, most guidelines have advocated for the treatment of cardiac sarcoidosis with corticosteroids. However, there is heterogeneity in disease presentation and response to treatment, which can make treatment challenging. The ability to identify disease phenotypes to allow for tailored therapy is therefore highly desirable. This review will seek to outline the disease phenotypes of cardiac sarcoidosis and the role that FDG-PET imaging can play in identifying these phenotypes to optimize disease diagnosis and treatment management. RECENT FINDINGS FDG PET can identify cardiac sarcoidosis and is being increasingly used to monitor therapeutic response to immunosuppressive therapy, to follow treatment response after discontinuation of corticosteroid therapy, and to evaluate for disease relapse. Modern quantitative techniques using FDG PET imaging may allow for even better phenotypic disease characterization and the ability to track the response to immunosuppression more accurately. FDG PET currently plays an important role in cardiac sarcoidosis diagnosis. However, it also affords us the opportunity to offer insights into cardiac sarcoidosis disease phenotypes to better understand the underlying disease process and in the future may allows us to tailor therapies accordingly.
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Affiliation(s)
- Kevin Emery Boczar
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada.
- School of Epidemiology and Public Health, Department of Medicine, University of Ottawa, Ottawa, Canada.
| | - Yooyhun Park
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Christiane Wiefels
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ottawa, Canada
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2
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Cheng RK, Kittleson MM, Beavers CJ, Birnie DH, Blankstein R, Bravo PE, Gilotra NA, Judson MA, Patton KK, Rose-Bovino L. Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1197-e1216. [PMID: 38634276 DOI: 10.1161/cir.0000000000001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Cardiac sarcoidosis is an infiltrative cardiomyopathy that results from granulomatous inflammation of the myocardium and may present with high-grade conduction disease, ventricular arrhythmias, and right or left ventricular dysfunction. Over the past several decades, the prevalence of cardiac sarcoidosis has increased. Definitive histological confirmation is often not possible, so clinicians frequently face uncertainty about the accuracy of diagnosis. Hence, the likelihood of cardiac sarcoidosis should be thought of as a continuum (definite, highly probable, probable, possible, low probability, unlikely) rather than in a binary fashion. Treatment should be initiated in individuals with clinical manifestations and active inflammation in a tiered approach, with corticosteroids as first-line treatment. The lack of randomized clinical trials in cardiac sarcoidosis has led to treatment decisions based on cohort studies and consensus opinions, with substantial variation observed across centers. This scientific statement is intended to guide clinical practice and to facilitate management conformity by providing a framework for the diagnosis and management of cardiac sarcoidosis.
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Ebbinghaus H, Ueberham L, Husser-Bollmann D, Bollmann A, Paetsch I, Jahnke C, Laufs U, Dinov B. Case Report: Four cases of cardiac sarcoidosis in patients with inherited cardiomyopathy-a phenotypic overlap, co-existence of two rare cardiomyopathies or a second-hit disease. Front Cardiovasc Med 2023; 10:1328802. [PMID: 38173816 PMCID: PMC10763246 DOI: 10.3389/fcvm.2023.1328802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Cardiac sarcoidosis (CS), a rare condition characterized by non-caseating granulomas, can manifest with symptoms such as atrioventricular block and ventricular tachycardia (VT), as well as mimic inherited cardiomyopathies. A 48-year-old male presented with recurrent VT. The initial 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) scan showed uptake of the mediastinal lymph node. Cardiovascular magnetic resonance (CMR) demonstrated intramyocardial fibrosis. The follow-up 18FDG-PET scan revealed the presence of tracer uptake in the left ventricular (LV) septum, suggesting the likelihood of CS. Genetic testing identified a pathogenic LMNA variant. A 47-year-old female presented with complaints of palpitations and syncope. An Ajmaline provocation test confirmed Brugada syndrome (BrS). CMR revealed signs of cardiac inflammation. An endomyocardial biopsy (EMB) confirmed the diagnosis of cardiac sarcoidosis. Polymorphic VT was induced during an electrophysiological study, and an implantable cardioverter-defibrillator (ICD) was implanted. A 58-year-old woman presented with sustained VT with a prior diagnosis of hypertrophic cardiomyopathy (HCM). A genetic work-up identified the presence of a heterozygous MYBC3 variant of unknown significance (VUS). CMR revealed late gadolinium enhancement (LGE), while the 18FDG-PET scan demonstrated LV tracer uptake. The immunosuppressive therapy was adjusted, and no further VTs were observed. A 28-year-old male athlete with right ventricular dilatation and syncope experienced a cardiac arrest during training. Genetic testing identified a pathogenic mutation in PKP2. The autopsy has confirmed the presence of ACM and a distinctive extracardiac sarcoidosis. Cardiac sarcoidosis and inherited cardiomyopathies may interact in several different ways, altering the clinical presentation. Overlapping pathologies are frequently overlooked. Delayed or incomplete diagnosis risks inadequate treatment. Thus, genetic testing and endomyocardial biopsies should be recommended to obtain a clear diagnosis.
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Affiliation(s)
- Hans Ebbinghaus
- Department for Electrophysiology, Heart Center of Leipzig, Leipzig, Germany
| | - Laura Ueberham
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig,Germany
| | | | - Andreas Bollmann
- Department for Electrophysiology, Heart Center of Leipzig, Leipzig, Germany
| | - Ingo Paetsch
- Department for Electrophysiology, Heart Center of Leipzig, Leipzig, Germany
| | - Cosima Jahnke
- Department for Electrophysiology, Heart Center of Leipzig, Leipzig, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig,Germany
| | - Borislav Dinov
- Department of Cardiology, Medical University of Giessen, Giessen, Germany
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Gasperetti A, James CA, Carrick RT, Protonotarios A, te Riele ASJM, Cadrin-Tourigny J, Compagnucci P, Duru F, van Tintelen P, Elliot PM, Calkins H. Arrhythmic risk stratification in arrhythmogenic right ventricular cardiomyopathy. Europace 2023; 25:euad312. [PMID: 37935403 PMCID: PMC10674106 DOI: 10.1093/europace/euad312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heritable cardiomyopathy characterized by a predominantly arrhythmic presentation. It represents the leading cause of sudden cardiac death (SCD) among athletes and poses a significant morbidity threat in the general population. As a causative treatment for ARVC is still not available, the placement of an implantable cardioverter defibrillator represents the current cornerstone for SCD prevention in this setting. Thanks to international ARVC-dedicated efforts, significant steps have been achieved in recent years towards an individualized, patient-centred risk stratification approach. A novel risk calculator algorithm estimating the 5-year risk of arrhythmias of patients with ARVC has been introduced in clinical practice and subsequently validated. The purpose of this article is to summarize the body of evidence that has allowed the development of this tool and to discuss the best way to implement its use in the care of an individual patient.
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MESH Headings
- Humans
- Risk Factors
- Arrhythmogenic Right Ventricular Dysplasia/complications
- Arrhythmogenic Right Ventricular Dysplasia/diagnosis
- Arrhythmogenic Right Ventricular Dysplasia/therapy
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/epidemiology
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Arrhythmias, Cardiac/complications
- Defibrillators, Implantable/adverse effects
- Risk Assessment
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Affiliation(s)
- Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Blalock 545, 600 N. Wolfe St., Baltimore, MD 21287, USA
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, Utrecht, The Netherlands
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Blalock 545, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Richard T Carrick
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Blalock 545, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | | | - Anneline S J M te Riele
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, Utrecht, The Netherlands
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | - Firat Duru
- Department of Cardiology, Arrhythmia Unit, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Peter van Tintelen
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - Perry M Elliot
- Department of Cardiology, UCL Institute of Cardiovascular Science, London, UK
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Blalock 545, 600 N. Wolfe St., Baltimore, MD 21287, USA
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Ranganathan D, Singh SM. Cardiac Sarcoidosis: More Than Meets the εye. Can J Cardiol 2023; 39:1649-1650. [PMID: 37673394 DOI: 10.1016/j.cjca.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023] Open
Affiliation(s)
- Deepti Ranganathan
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Sheldon M Singh
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Ontario, Canada.
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Fujita M, Takeda Y, Ohtani T, Nakatani S, Ueno T, Sakata Y. A case of cardiac sarcoidosis mimicking arrhythmogenic right ventricular cardiomyopathy. J Echocardiogr 2023:10.1007/s12574-023-00627-7. [PMID: 37856042 DOI: 10.1007/s12574-023-00627-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Mariko Fujita
- Department of Medical Technology, Osaka University Hospital, Suita, Japan
| | - Yasuharu Takeda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Satoshi Nakatani
- Division of Cardiology, Osaka Saiseikai Senri Hospital, Suita, Japan
| | - Tomohiro Ueno
- Department of Medical Technology, Osaka University Hospital, Suita, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Patel R, Mistry AM, Mulukutla V, Prajapati K. Cardiac Sarcoidosis: A Literature Review of Current Recommendations on Diagnosis and Management. Cureus 2023; 15:e41451. [PMID: 37546036 PMCID: PMC10404059 DOI: 10.7759/cureus.41451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Cardiac sarcoidosis (CS) is a rare multisystem disorder characterized by granulomatous infiltration of the myocardium, which can lead to significant morbidity and mortality. Its clinical manifestations range from asymptomatic conduction abnormalities to severe heart failure (HF) and sudden cardiac death. This comprehensive review aims to provide an overview of the diagnosis, clinical features, and current medical management strategies for CS. Additionally, the role of implantable cardioverter-defibrillators (ICDs) and the potential use of positron emission tomography in guiding management decisions are explored. A comprehensive understanding of the medical management of CS is essential for improving patient outcomes and guiding future research endeavors.
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Affiliation(s)
- Rutul Patel
- Internal Medicine, Texas Tech University Health Sciences Center, El Paso, USA
| | - Anuja Mahesh Mistry
- Internal Medicine, Texas Tech University Health Sciences Center, El Paso, USA
| | | | - Krupal Prajapati
- Internal Medicine, Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
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Kurashima S, Kitai T, Xanthopoulos A, Skoularigis J, Triposkiadis F, Izumi C. Diagnosis of cardiac sarcoidosis: histological evidence vs. imaging. Expert Rev Cardiovasc Ther 2023; 21:693-702. [PMID: 37776232 DOI: 10.1080/14779072.2023.2266367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/29/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION The prognosis for cardiac sarcoidosis (CS) remains unfavorable. Although early and accurate diagnosis is crucial, the low detection rate of endomyocardial biopsy makes accurate diagnosis challenging. AREAS COVERED The Heart Rhythm Society (HRS) consensus statement and the Japanese Circulation Society (JCS) guidelines are two major diagnostic criteria for the diagnosis of CS. While the requirement of positive histology for the diagnosis in the HRS criteria can result in overlooked cases, the JCS guidelines advocate for a group of 'clinical' diagnoses based on advanced imaging, including cardiovascular magnetic resonance and 18F-fluorodeoxyglucose positron emission tomography, which do not require histological evidence. Recent studies have supported the usefulness of clinical diagnosis of CS. However, other evidence suggests that clinical CS may sometimes be inaccurate. This article describes the advantages and disadvantages of the current diagnostic criteria for CS, and typical imaging and clinical courses. EXPERT OPINION The diagnosis of clinical CS has been made possible by recent developments in multimodality imaging. However, it is still crucial to look for histological signs of sarcoidosis in other organs in addition to the endomyocardium. Additionally, phenotyping based on clinical manifestations such as heart failure, conduction abnormality or ventricular arrhythmia, and extracardiac abnormalities is clinically significant.
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Affiliation(s)
- Shinichi Kurashima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | | | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Mkoko P, Chin A. Diagnoses, management patterns, and outcomes of cardiac sarcoidosis in South Africa. Heart Rhythm O2 2023; 4:343-349. [PMID: 37361621 PMCID: PMC10288020 DOI: 10.1016/j.hroo.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Background Sarcoidosis is an idiopathic multiorgan disease characterized by tissue infiltration by noncaseating granulomas. Clinical cardiac involvement is reported in approximately 5% of patients. However, the frequency of cardiac involvement is found to be higher on autopsy and in advanced imaging studies such as cardiac magnetic resonance imaging. Objective The purpose of this study was to determine contemporary diagnoses, management, and outcomes of cardiac sarcoidosis (CS) in South Africa. Methods Clinical records of patients diagnosed with CS between January 2000 and December 2021 were reviewed. Results Twenty-two patients were diagnosed with CS during the study period. The patients had a mean (± SD) age of 45.2 ± 12.3 years at the time of presentation. CS diagnostic rates increased from 4.5% in 2000-2005 to 45.5% in 2016-2021. Fifteen of the 22 patients (68.2%) were newly diagnosed with sarcoidosis at the time of CS diagnosis, and 9 of the 15 (60%) had pulmonary involvement. Of the 22 patients diagnosed with CS, 13 (59.1%) presented in combination with heart block, 10 (45.5%) with ventricular arrhythmias, and 4 (18.2%) with heart failure. Five endomyocardial biopsies were performed, and all were nondiagnostic. However, 8 of 8 endobronchial ultrasound (EBUS)-guided biopsies of thoracic lymph nodes were diagnostic of sarcoidosis and, notably, excluded tuberculosis. Fourteen patients (63.6%) were treated with corticosteroids, 7 (31.8%) with azathioprine, 9 (40.9%) with amiodarone, and 16 (72.7%) with a cardiac implantable electronic device. After a mean follow-up period of 64.5 ± 50.5 months, no deaths had occurred. Conclusion CS diagnostic rates have increased over time. Diagnostic endomyocardial biopsies have a low diagnostic yield, whereas EBUS-guided biopsy of thoracic lymph nodes is of crucial diagnostic utility.
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Affiliation(s)
- Philasande Mkoko
- Cardiac Clinic, Charlotte Maxeke Johannesburg Academic Hospital, Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashley Chin
- E17 Cardiac Clinic, Groote Schuur Hospital, Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Cherrett C, Lee W, Bart N, Subbiah R. Management of the arrhythmic manifestations of cardiac sarcoidosis. Front Cardiovasc Med 2023; 10:1104947. [PMID: 37304969 PMCID: PMC10248162 DOI: 10.3389/fcvm.2023.1104947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Cardiac sarcoidosis (CS) is characterised by a high burden of arrhythmic manifestations and cardiac electrophysiologists play an important role in both the diagnosis and management of this challenging condition. CS is characterised by the formation of noncaseating granulomas within the myocardium, which can subsequently lead to fibrosis. Clinical presentations of CS are varied and depend on the location and extent of granulomas. Patients may present with atrioventricular block, ventricular arrhythmias, sudden cardiac death or heart failure. CS is being increasing diagnosed through use of advanced cardiac imaging, however endomyocardial biopsy is often still required to confirm the diagnosis. Due to the low sensitivity of fluoroscopy-guided right ventricular biopsies, three-dimensional electro-anatomical mapping and electrogram-guided biopsies are being investigated as a means to improve diagnostic yield. Cardiac implantable electronic devices are often required in the management of CS, either for pacing or for primary or secondary prevention of ventricular arrhythmias. Catheter ablation for ventricular arrythmias may also be required, although this is often associated with high recurrence rates due to the challenging nature of the arrhythmogenic substrate. This review will explore the underlying mechanisms of the arrhythmic manifestations of CS, provide an overview of current clinical practice guidelines, and examine the important role that cardiac electrophysiologists play in managing patients with CS.
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Affiliation(s)
- Callum Cherrett
- Cardiology Department, St Vincent’s Hospital Sydney, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - William Lee
- Cardiology Department, St Vincent’s Hospital Sydney, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Nicole Bart
- Cardiology Department, St Vincent’s Hospital Sydney, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Rajesh Subbiah
- Cardiology Department, St Vincent’s Hospital Sydney, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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Abstract
The diagnostic yield of endomyocardial biopsy in cardiac sarcoidosis (CS) is quite low because of the patchy involvement, and for the diagnosis of CS, existing guidelines required histological confirmation. Therefore, especially for isolated CS, diagnosis consistent with the guidelines cannot be made in a large number of patients. With recent developments in imaging modalities such as cardiac magnetic resonance and 18-fluorodeoxyglucose positron emission tomography, diagnosing CS has become easier and diagnostic criteria for CS not compulsorily requiring histological confirmation have been suggested. Despite significant advances in diagnostic tools, large-scale studies that can guide treatment plans are still lacking, and treatment has relied on the experience accumulated over the past years and the consensus of experts. However, opinions vary, depending on the situation, which is quite puzzling for the physician treating CS. Moreover, with the advent of new immunosuppressant agents, these new drugs have been applied under the assumption that the effect of immunosuppression is not much different from that of other well-known autoimmune diseases that require immunosuppression. However, we should wait to see the beneficial effects of these new immunosuppressants before we attempt to apply these agents in our clinical practice. This review summarises the widely used diagnostic criteria, current diagnostic modalities and recommended treatments for sarcoidosis. We have added our opinions on selecting or modifying diagnostic and treatment plans from the diverse current recommendations.
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Affiliation(s)
- Dae-Won Sohn
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea .,Seoul One-Heart CV Clinic, Seoul, South Korea
| | - Jun-Bean Park
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea
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12
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Arrhythmogenic Right Ventricular Cardiomyopathy. JACC Clin Electrophysiol 2022; 8:533-553. [PMID: 35450611 DOI: 10.1016/j.jacep.2021.12.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 01/21/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) encompasses a group of conditions characterized by right ventricular fibrofatty infiltration, with a predominant arrhythmic presentation. First described in the late 1970s and early 1980s, it is now frequently recognized to have biventricular involvement. The prevalence is ∼1:2,000 to 1:5,000, depending on geographic location, and it has a slight male predominance. The diagnosis of ARVC is determined on the basis of fulfillment of task force criteria incorporating electrophysiological parameters, cardiac imaging findings, genetic factors, and histopathologic features. Risk stratification of patients with ARVC aims to identify those who are at increased risk of sudden cardiac death or sustained ventricular tachycardia. Factors including age, sex, electrophysiological features, and cardiac imaging investigations all contribute to risk stratification. The current management of ARVC includes exercise restriction, β-blocker therapy, consideration for implantable cardioverter-defibrillator insertion, and catheter ablation. This review summarizes our current understanding of ARVC and provides clinicians with a practical approach to diagnosis and management.
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13
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Molitor N, Duru F. Arrhythmogenic Right Ventricular Cardiomyopathy and Differential Diagnosis with Diseases Mimicking Its Phenotypes. J Clin Med 2022; 11:jcm11051230. [PMID: 35268321 PMCID: PMC8911116 DOI: 10.3390/jcm11051230] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 12/13/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart muscle disease, which is characterized by fibro-fatty replacement of predominantly the right ventricle (RV). The disease can result in ventricular tachyarrhythmias and sudden cardiac death. Our understanding of the pathophysiology and clinical expressivity of ARVC has been continuously evolving. The diagnosis can be challenging due to its variable expressivity, incomplete penetrance and the lack of specific diagnostic criteria. Idiopathic RV outflow tract tachycardia, Brugada Syndrome, athlete’s heart, dilated cardiomyopathy, myocarditis, cardiac sarcoidosis, congenital aneurysms and diverticula may mimic clinical phenotypes of ARVC. This review aims to provide an update on the differential diagnosis of ARVC.
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Affiliation(s)
- Nadine Molitor
- Division of Arrhythmias and Electrophysiology, Clinic for Cardiology, University Heart Center Zurich, 8091 Zurich, Switzerland;
| | - Firat Duru
- Division of Arrhythmias and Electrophysiology, Clinic for Cardiology, University Heart Center Zurich, 8091 Zurich, Switzerland;
- Center for Integrative Human Physiology, University of Zurich, 8057 Zurich, Switzerland
- Correspondence: ; Tel.: +41-44-2553565
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14
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Meraviglia V, Alcalde M, Campuzano O, Bellin M. Inflammation in the Pathogenesis of Arrhythmogenic Cardiomyopathy: Secondary Event or Active Driver? Front Cardiovasc Med 2022; 8:784715. [PMID: 34988129 PMCID: PMC8720743 DOI: 10.3389/fcvm.2021.784715] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/30/2021] [Indexed: 12/27/2022] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a rare inherited cardiac disease characterized by arrhythmia and progressive fibro-fatty replacement of the myocardium, which leads to heart failure and sudden cardiac death. Inflammation contributes to disease progression, and it is characterized by inflammatory cell infiltrates in the damaged myocardium and inflammatory mediators in the blood of ACM patients. However, the molecular basis of inflammatory process in ACM remains under investigated and it is unclear whether inflammation is a primary event leading to arrhythmia and myocardial damage or it is a secondary response triggered by cardiomyocyte death. Here, we provide an overview of the proposed players and triggers involved in inflammation in ACM, focusing on those studied using in vivo and in vitro models. Deepening current knowledge of inflammation-related mechanisms in ACM could help identifying novel therapeutic perspectives, such as anti-inflammatory therapy.
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Affiliation(s)
- Viviana Meraviglia
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Mireia Alcalde
- Cardiovascular Genetics Center, University of Girona-IdIBGi, Girona, Spain.,Centro Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Oscar Campuzano
- Cardiovascular Genetics Center, University of Girona-IdIBGi, Girona, Spain.,Centro Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Medical Science Department, School of Medicine, University of Girona, Girona, Spain
| | - Milena Bellin
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands.,Department of Biology, University of Padua, Padua, Italy.,Veneto Institute of Molecular Medicine, Padua, Italy
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15
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Rangaswamy VV, Saggu DK, Yalagudri S, Calambur N. A case of cardiac sarcoidosis mimiking Brugada syndrome. Indian Pacing Electrophysiol J 2021; 22:47-50. [PMID: 34673214 PMCID: PMC8811276 DOI: 10.1016/j.ipej.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/30/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022] Open
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.
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16
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Makhdumi M, Assar MD, Meyer DM, Roberts WC. Cardiac sarcoidosis diagnosed after orthotopic heart transplantation and clinically mimicking arrhythmogenic right ventricular cardiomyopathy. Cardiovasc Pathol 2021; 56:107390. [PMID: 34600147 DOI: 10.1016/j.carpath.2021.107390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
Described herein is a 71-year-old man who underwent orthotopic heart transplant (OHT) for chronic severe heart failure secondary to cardiac sarcoidosis (CS) devoid of non-caseating granulomas but nevertheless characteristic of CS. Clinically, his heart disease had suggested the presence of arrhythmogenic right ventricular cardiomyopathy.
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Affiliation(s)
- Madiha Makhdumi
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, United States
| | - Manish D Assar
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, United States; Internal Medicine, Baylor University Medical Center, Dallas, Texas, United States
| | - Dan M Meyer
- Departments of Cardiac Surgery, Baylor University Medical Center, Dallas, Texas, United States; Internal Medicine, Baylor University Medical Center, Dallas, Texas, United States
| | - William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, United States; Internal Medicine, Baylor University Medical Center, Dallas, Texas, United States.
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17
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Palmisano A, Darvizeh F, Cundari G, Rovere G, Ferrandino G, Nicoletti V, Cilia F, De Vizio S, Palumbo R, Esposito A, Francone M. Advanced cardiac imaging in athlete's heart: unravelling the grey zone between physiologic adaptation and pathology. Radiol Med 2021; 126:1518-1531. [PMID: 34420142 PMCID: PMC8380417 DOI: 10.1007/s11547-021-01411-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/06/2021] [Indexed: 12/11/2022]
Abstract
Over the last decades, interest toward athlete’s heart has progressively increased, leading to improve the knowledge on exercise-induced heart modifications. Sport may act as a trigger for life-threatening arrhythmias in patients with structural or electrical abnormalities, hence requiring to improve the diagnostic capability to differentiate physiological from pathological remodeling. Pathological alterations are often subtle at the initial stages; therefore, the challenge is to promptly identify athletes at risk of sudden cardiac death during the pre-participation screening protocols. Advanced imaging modalities such as coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) can non-invasively depict coronary vessels and provide a deep morpho-functional and structural characterization of the myocardium, in order to rule out pathological life threatening alterations, which may overlap with athletes’ heart remodeling. The purpose of the present narrative review is to provide an overview of most frequent diagnostic challenges, defining the boundaries between athlete's heart remodeling and pathological structural alteration with a focus on the role and importance of CCTA and CMR.
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Affiliation(s)
- Anna Palmisano
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Fatemeh Darvizeh
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia Cundari
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Rovere
- Department of Radiological and Hematological Sciences -Section of Radiology, Università Cattolica Sacro Cuore, Fondazione, Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Valeria Nicoletti
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Cilia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvia De Vizio
- Department of Radiological and Hematological Sciences -Section of Radiology, Università Cattolica Sacro Cuore, Fondazione, Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Palumbo
- School of Radiology, Campus BioMedico Univerisity, Rome, Italy
| | - Antonio Esposito
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. .,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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18
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Gilotra NA, Griffin JM, Pavlovic N, Houston BA, Chasler J, Goetz C, Chrispin J, Sharp M, Kasper EK, Chen ES, Blankstein R, Cooper LT, Joyce E, Sheikh FH. Sarcoidosis-Related Cardiomyopathy: Current Knowledge, Challenges, and Future Perspectives State-of-the-Art Review. J Card Fail 2021; 28:113-132. [PMID: 34260889 DOI: 10.1016/j.cardfail.2021.06.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/21/2021] [Indexed: 12/21/2022]
Abstract
The prevalence of sarcoidosis-related cardiomyopathy is increasing. Sarcoidosis impacts cardiac function through granulomatous infiltration of the heart, resulting in conduction disease, arrhythmia, and/or heart failure. The diagnosis of cardiac sarcoidosis (CS) can be challenging and requires clinician awareness as well as differentiation from overlapping diagnostic phenotypes, such as other forms of myocarditis and arrhythmogenic cardiomyopathy. Clinical manifestations, extracardiac involvement, histopathology, and advanced cardiac imaging can all lend support to a diagnosis of CS. The mainstay of therapy for CS is immunosuppression; however, no prospective clinical trials exist to guide management. Patients may progress to developing advanced heart failure or ventricular arrhythmia, for which ventricular assist device therapies or heart transplantation may be considered. The existing knowledge gaps in CS call for an interdisciplinary approach to both patient care and future investigation to improve mechanistic understanding and therapeutic strategies.
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Affiliation(s)
- Nisha A Gilotra
- Advanced Heart Failure/Transplant Cardiology Section, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Jan M Griffin
- Advanced Heart Failure/Transplant Cardiology Section, Division of Cardiology, Columbia University School of Medicine, New York, New York
| | - Noelle Pavlovic
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Brian A Houston
- Advanced Heart Failure/Transplant Cardiology Section, Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Jessica Chasler
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland
| | - Colleen Goetz
- Infiltrative Cardiomyopathy and Advanced Heart Failure Programs, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Jonathan Chrispin
- Clinical Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle Sharp
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edward K Kasper
- Advanced Heart Failure/Transplant Cardiology Section, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edward S Chen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ron Blankstein
- Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Emer Joyce
- Department of Cardiology, Mater Misericordiae University Hospital and University College Dublin School of Medicine, Dublin, Ireland
| | - Farooq H Sheikh
- Infiltrative Cardiomyopathy and Advanced Heart Failure Programs, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
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19
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Kupari M, Lehtonen J. POINT: Should Isolated Cardiac Sarcoidosis Be Considered a Significant Manifestation of Sarcoidosis? Yes. Chest 2021; 160:36-38. [PMID: 34246374 DOI: 10.1016/j.chest.2020.12.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/13/2020] [Indexed: 10/20/2022] Open
Affiliation(s)
- Markku Kupari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
| | - Jukka Lehtonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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20
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Saturi G, Caponetti AG, Leone O, Lovato L, Longhi S, Graziosi M, Ditaranto R, Biffi M, Galiè N, Biagini E. Cum Grano Salis: Cardiac Sarcoidosis as a Perfect Mimic of Arrhythmogenic Right Ventricular Cardiomyopathy. Circ Cardiovasc Imaging 2021; 14:e012355. [PMID: 34187167 DOI: 10.1161/circimaging.120.012355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giulia Saturi
- Cardiology Unit, Cardio-Thoracic-Vascular Department, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (G.S., A.G.C., S.L., M.G., R.D., M.B., N.G., E.B.).,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy (G.S., A.G.C., R.D., N.G.)
| | - Angelo Giuseppe Caponetti
- Cardiology Unit, Cardio-Thoracic-Vascular Department, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (G.S., A.G.C., S.L., M.G., R.D., M.B., N.G., E.B.).,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy (G.S., A.G.C., R.D., N.G.)
| | - Ornella Leone
- Cardiovascular Pathology Unit, Department of Pathology, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (O.L.)
| | - Luigi Lovato
- Cardio-Thoracic Radiology Unit, Cardio-Thoracic-Vascular Department, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (L.L.)
| | - Simone Longhi
- Cardiology Unit, Cardio-Thoracic-Vascular Department, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (G.S., A.G.C., S.L., M.G., R.D., M.B., N.G., E.B.)
| | - Maddalena Graziosi
- Cardiology Unit, Cardio-Thoracic-Vascular Department, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (G.S., A.G.C., S.L., M.G., R.D., M.B., N.G., E.B.)
| | - Raffaello Ditaranto
- Cardiology Unit, Cardio-Thoracic-Vascular Department, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (G.S., A.G.C., S.L., M.G., R.D., M.B., N.G., E.B.).,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy (G.S., A.G.C., R.D., N.G.)
| | - Mauro Biffi
- Cardiology Unit, Cardio-Thoracic-Vascular Department, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (G.S., A.G.C., S.L., M.G., R.D., M.B., N.G., E.B.)
| | - Nazzareno Galiè
- Cardiology Unit, Cardio-Thoracic-Vascular Department, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (G.S., A.G.C., S.L., M.G., R.D., M.B., N.G., E.B.).,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy (G.S., A.G.C., R.D., N.G.)
| | - Elena Biagini
- Cardiology Unit, Cardio-Thoracic-Vascular Department, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (G.S., A.G.C., S.L., M.G., R.D., M.B., N.G., E.B.)
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21
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Diagnosis of cardiac sarcoidosis: a primer for non-imagers. Heart Fail Rev 2021; 27:1223-1233. [PMID: 34185203 DOI: 10.1007/s10741-021-10126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Sarcoidosis is a multisystem granulomatous disorder that can potentially involve any organ. Cardiac involvement in sarcoidosis has been reported in up to 25% of patients based on autopsy and imaging studies. The gold standard for diagnosing cardiac sarcoidosis is endomyocardial biopsy demonstrating non-caseating granulomas; however, this technique lacks sensitivity due to the patchy nature of myocardial involvement. This, along with the non-specific clinical presentation, renders the diagnosis of cardiac sarcoidosis extremely challenging. Difficulties in obtaining histopathologic diagnosis and the advances in imaging modalities have led to a paradigm shift toward non-invasive imaging in the diagnosis of cardiac sarcoidosis. Advances in cardiac imaging modalities have also allowed unprecedented insights into the prevalence and natural history of cardiac sarcoidosis. This review discusses the role of non-invasive imaging for diagnosis, risk stratification, and monitoring the response to therapies in cardiac sarcoidosis. Echocardiography remains the first-line modality due to widespread availability and affordability. Cardiac magnetic resonance imaging (CMR) can be used to study cardiac structure, function, and most importantly tissue characterization to detect inflammation and fibrosis. Fluoro-deoxy glucose positron emission tomography (FDG PET) is the gold standard for non-invasive detection of cardiac inflammation, and it offers the unique ability to assess response to therapeutic interventions. Hybrid imaging is a promising technique that allows us to combine the unique strengths of CMR and FDG PET. Understanding the advantages and disadvantages of each of these imaging modalities is crucial in order to tailor the diagnostic algorithm and utilize the most appropriate modality for each patient.
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22
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Hoogendoorn JC, Venlet J, Out YNJ, Man S, Kumar S, Sramko M, Dechering DG, Nakajima I, Siontis KC, Watanabe M, Nakamura Y, Tedrow UB, Bogun F, Eckardt L, Peichl P, Stevenson WG, Zeppenfeld K. The precordial R' wave: A novel discriminator between cardiac sarcoidosis and arrhythmogenic right ventricular cardiomyopathy in patients presenting with ventricular tachycardia. Heart Rhythm 2021; 18:1539-1547. [PMID: 33957319 DOI: 10.1016/j.hrthm.2021.04.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/16/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cardiac sarcoidosis (CS) with right ventricular (RV) involvement can mimic arrhythmogenic right ventricular cardiomyopathy (ARVC). Histopathological differences may result in disease-specific RV activation patterns detectable on the 12-lead electrocardiogram. Dominant subepicardial scar in ARVC leads to delayed activation of areas with reduced voltages, translating into terminal activation delay and occasionally (epsilon) waves with a small amplitude. Conversely, patchy transmural RV scar in CS may lead to conduction block and therefore late activated areas with preserved voltages reflected as preserved R' waves. OBJECTIVE The purpose of this study was to evaluate the distinct terminal activation patterns in precordial leads V1 through V3 as a discriminator between CS and ARVC. METHODS Thirteen patients with CS affecting the RV and 23 patients with gene-positive ARVC referred for ventricular tachycardia ablation were retrospectively included in a multicenter approach. A non-ventricular-paced 12-lead surface electrocardiogram was analyzed for the presence and the surface area of the R' wave (any positive deflection from baseline after an S wave) in leads V1 through V3. RESULTS An R' wave in leads V1 through V3 was present in all patients with CS compared to 11 (48%) patients with ARVC (P = .002). An algorithm including a PR interval of ≥220 ms, the presence of an R' wave, and the surface area of the maximum R' wave in leads V1 through V3 of ≥1.65 mm2 had 85% sensitivity and 96% specificity for diagnosing CS, validated in a second cohort (18 CS and 40 ARVC) with 83% sensitivity and 88% specificity. CONCLUSION An easily applicable algorithm including PR prolongation and the surface area of the maximum R' wave in leads V1 through V3 of ≥1.65 mm2 distinguishes CS from ARVC. This QRS terminal activation in precordial leads V1 through V3 may reflect disease-specific scar patterns.
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Affiliation(s)
- Jarieke C Hoogendoorn
- Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen Venlet
- Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, The Netherlands
| | - Yannick N J Out
- Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, The Netherlands
| | - Sumche Man
- Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, The Netherlands
| | - Saurabh Kumar
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marek Sramko
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, The Czech Republic
| | - Dirk G Dechering
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Münster, Germany
| | - Ikutaro Nakajima
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Konstantinos C Siontis
- Department of Cardiology, University of Michigan, Ann Arbor, Michigan; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Masaya Watanabe
- Department of Cardiology, Hokkaido University Hospital, Hokkaido, Japan
| | - Yoshinori Nakamura
- Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, The Netherlands
| | - Usha B Tedrow
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Frank Bogun
- Department of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Lars Eckardt
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Münster, Germany
| | - Petr Peichl
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, The Czech Republic
| | - William G Stevenson
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katja Zeppenfeld
- Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, The Netherlands.
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23
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Rosenfeld LE, Chung MK, Harding CV, Spagnolo P, Grunewald J, Appelbaum J, Sauer WH, Culver DA, Joglar JA, Lin BA, Jellis CL, Dickfeld TM, Kwon DH, Miller EJ, Cremer PC, Bogun F, Kron J, Bock A, Mehta D, Leis P, Siontis KC, Kaufman ES, Crawford T, Zimetbaum P, Zishiri ET, Singh JP, Ellenbogen KA, Chrispin J, Quadri S, Vincent LL, Patton KK, Kalbfleish S, Callahan TD, Murgatroyd F, Judson MA, Birnie D, Okada DR, Maulion C, Bhat P, Bellumkonda L, Blankstein R, Cheng RK, Farr MA, Estep JD. Arrhythmias in Cardiac Sarcoidosis Bench to Bedside: A Case-Based Review. Circ Arrhythm Electrophysiol 2021; 14:e009203. [PMID: 33591816 DOI: 10.1161/circep.120.009203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cardiac sarcoidosis is a component of an often multiorgan granulomatous disease of still uncertain cause. It is being recognized with increasing frequency, mainly as the result of heightened awareness and new diagnostic tests, specifically cardiac magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography scans. The purpose of this case-based review is to highlight the potentially life-saving importance of making the early diagnosis of cardiac sarcoidosis using these new tools and to provide a framework for the optimal care of patients with this disease. We will review disease mechanisms as currently understood, associated arrhythmias including conduction abnormalities, and atrial and ventricular tachyarrhythmias, guideline-directed diagnostic criteria, screening of patients with extracardiac sarcoidosis, and the use of pacemakers and defibrillators in this setting. Treatment options, including those related to heart failure, and those which may help clarify disease mechanisms are included.
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Affiliation(s)
- Lynda E Rosenfeld
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (L.E.R., E.J.M., C.M., L.B.)
| | - Mina K Chung
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
| | - Clifford V Harding
- Department of Pathology, Case Western Reserve University, Cleveland, OH (C.V.H.)
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy (P.S.)
| | | | - Jason Appelbaum
- University of Maryland School of Medicine, Baltimore (J.A., T.-M.D.)
| | - William H Sauer
- Brigham and Women's Hospital (W.H.S., R.B.), Harvard Medical School, Boston, MA
| | - Daniel A Culver
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
| | - Jose A Joglar
- University of Texas-Southwestern Medical Center, Dallas (J.A.J.)
| | - Ben A Lin
- Keck School of Medicine, University of Southern California, Los Angeles (B.A.L.)
| | - Christine L Jellis
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
| | | | - Deborah H Kwon
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
| | - Edward J Miller
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (L.E.R., E.J.M., C.M., L.B.)
| | - Paul C Cremer
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
| | - Frank Bogun
- University of Michigan Medical School, Ann Arbor (F.B., T.C.)
| | - Jordana Kron
- Virginia Commonwealth University School of Medicine, Richmond (J.K., K.A.E.)
| | - Ashley Bock
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
| | - Davendra Mehta
- Icahn School of Medicine Mount Sinai, New York City, NY (D.M., P.L.)
| | - Paul Leis
- Icahn School of Medicine Mount Sinai, New York City, NY (D.M., P.L.)
| | | | - Elizabeth S Kaufman
- Metro Health Campus, Case Western Reserve University, Cleveland, OH (E.S.K.)
| | - Thomas Crawford
- University of Michigan Medical School, Ann Arbor (F.B., T.C.)
| | - Peter Zimetbaum
- Beth Israel Deaconess Medical Center (P.Z.), Harvard Medical School, Boston, MA
| | - Edwin T Zishiri
- Michigan Heart and Vascular Institute, Ypsilanti, MI (E.T.Z.)
| | - Jagmeet P Singh
- Massachusetts General Hospital (J.P.S.), Harvard Medical School, Boston, MA
| | | | - Jonathan Chrispin
- Johns Hopkins University School of Medicine, Baltimore, MD (J.C., D.R.O.)
| | - Syed Quadri
- George Washington University School of Medicine, Washington DC (S.Q.)
| | - Logan L Vincent
- University of Washington School of Medicine, Seattle (L.L.V., K.K.P., R.K.C.)
| | - Kristen K Patton
- University of Washington School of Medicine, Seattle (L.L.V., K.K.P., R.K.C.)
| | | | - Thomas D Callahan
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
| | | | | | - David Birnie
- University of Ottawa Heart Institute, ON, Canada (D.B.)
| | - David R Okada
- Johns Hopkins University School of Medicine, Baltimore, MD (J.C., D.R.O.)
| | - Christopher Maulion
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (L.E.R., E.J.M., C.M., L.B.)
| | - Pavan Bhat
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
| | - Lavanya Bellumkonda
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (L.E.R., E.J.M., C.M., L.B.)
| | - Ron Blankstein
- Brigham and Women's Hospital (W.H.S., R.B.), Harvard Medical School, Boston, MA
| | - Richard K Cheng
- University of Washington School of Medicine, Seattle (L.L.V., K.K.P., R.K.C.)
| | - Maryjane A Farr
- Columbia University Irving Medical Center, New York City, NY (M.A.F.)
| | - Jerry D Estep
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
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24
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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25
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Hauer RNW. Cardiac sarcoidosis mimicking definite arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm 2020; 18:239-240. [PMID: 33091604 DOI: 10.1016/j.hrthm.2020.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Richard N W Hauer
- Department of Cardiology, University Medical Center Utrecht, Netherlands Heart Institute, Utrecht, The Netherlands.
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26
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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27
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Palumbo P, Cannizzaro E, Di Cesare A, Bruno F, Schicchi N, Giovagnoni A, Splendiani A, Barile A, Masciocchi C, Di Cesare E. Cardiac magnetic resonance in arrhythmogenic cardiomyopathies. Radiol Med 2020; 125:1087-1101. [PMID: 32978708 DOI: 10.1007/s11547-020-01289-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022]
Abstract
Over the past few years, the approach to the 'arrhythmic patient' has profoundly changed. An early clinical presentation of arrhythmia is often accompanied by non-specific symptoms and followed by inconclusive electrocardiographic findings. In this scenario, cardiac magnetic resonance (CMR) has been established as a clinical tool of fundamental importance for a correct prognostic stratification of the arrhythmic patient. This technique provides a high-spatial-resolution tomographic evaluation of the heart, which allows studying accurately the ventricular volumes, identifying even segmental kinetic anomalies and properly detecting diffuse or focal tissue alterations through an excellent tissue characterization, while depicting different patterns of fibrosis distribution, myocardial edema or fatty substitution. Through these capabilities, CMR has a pivotal role for the adequate management of the arrhythmic patient, allowing the identification of those phenotypic manifestations characteristic of structural heart diseases. Therefore, CMR provides valuable information to reclassify the patient within the wide spectrum of potentially arrhythmogenic heart diseases, the definition of which remains the major determinants for both an adequate treatment and a poor prognosis. The purpose of this review study was to focus on the role of CMR in the evaluation of the main cardiac clinical entities associated with arrhythmogenic phenomena and to present a brief debate on the main pathophysiological mechanisms involved in the arrhythmogenesis process.
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Affiliation(s)
- Pierpaolo Palumbo
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, AQ, Italy.
| | | | - Annamaria Di Cesare
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, AQ, Italy
| | - Nicolò Schicchi
- Department of Radiology, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, AQ, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, AQ, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, AQ, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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28
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Differentiating hereditary arrhythmogenic right ventricular cardiomyopathy from cardiac sarcoidosis fulfilling 2010 ARVC Task Force Criteria. Heart Rhythm 2020; 18:231-238. [PMID: 32976989 DOI: 10.1016/j.hrthm.2020.09.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/16/2020] [Accepted: 09/19/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The clinical presentation of cardiac sarcoidosis (CS) may resemble that of arrhythmogenic right ventricular cardiomyopathy (ARVC). OBJECTIVE The purpose of this study was to identify clinical variables to better discriminate between patients with genetically determined ARVC and those with CS fulfilling definite 2010 ARVC Task Force Criteria (TFC). METHODS In this multicenter study, 10 patients with CS fulfilling definite 2010 ARVC TFC were age and gender matched with 10 genetically proven ARVC patients. A cardiac 18F-fluorodeoxyglucose positron emission tomographic (18F-FDG PET) scan was required for patients to be included in the study. RESULTS The 2010 ARVC TFC did not reliably differentiate between the 2 diseases. CS patients presented with longer PR intervals, advanced atrioventricular block (AVB), and longer QRS duration (P <.001 and P = .009, respectively), whereas T-wave inversions (TWIs) in the peripheral leads were more common in ARVC patients (P = .009). CS patients presented with more extensive left ventricular involvement and lower left ventricular ejection fraction (LVEF), whereas ARVC patients had a larger right ventricular outflow tract (RVOT) (P = .044). PET scan positivity was only present in CS patients (90% vs 0%). CONCLUSION The 2010 ARVC TFC do not reliably differentiate between CS patients fulfilling 2010 ARVC TFC and those with hereditary ARVC. Prolonged PR interval, advanced AVB, longer QRS duration, right ventricular apical involvement, reduced LVEF, and positive 18F-FDG PET scan should raise the suspicion of CS, whereas larger RVOT dimensions, subtricuspid involvement and peripheral TWI favor a diagnosis of hereditary ARVC.
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29
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Cipriani A, Perazzolo Marra M, Bariani R, Mattesi G, Vio R, Bettella N, DE Lazzari M, Motta R, Bauce B, Zorzi A, Corrado D. Differential diagnosis of arrhythmogenic cardiomyopathy: phenocopies versus disease variants. Minerva Med 2020; 112:269-280. [PMID: 32700864 DOI: 10.23736/s0026-4806.20.06782-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a genetic heart muscle disease caused by mutations of desmosomal genes in about 50% of patients. Affected patients may have defective non-desmosomal genes. The ACM phenotype may occur in other genetic cardiomyopathies, cardio-cutaneous syndromes or neuromuscular disorders. A sizeable proportion of patients have non-genetic diseases with clinical features resembling ACM (phenocopies). The identification of biventricular and left-dominant phenotypic variants has made differential diagnosis more difficult because of the broader spectrum of phenocopies which requires a detailed clinical study with appropriate evaluation of most prominent and discriminatory disease features. Conditions that enter into differential diagnosis of ACM include heart muscle diseases affecting the right ventricle, the left ventricle, or both. To confirm a conclusive diagnosis of ACM, these differential possibilities need to be reasonably excluded by an accurate and targeted clinical evaluation. This article reviews the clinical and imaging features of major phenocopies of ACM and provides indications for differential diagnosis. The recent etiologic classification of Arrhythmogenic Cardiomyopathies, whose common denominator is the distinctive phenotype characterized by a hypokinetic and non-dilated ventricle with a large amount of myocardial fibrosis underlying its propensity to generate ventricular arrhythmias is also addressed.
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Affiliation(s)
- Alberto Cipriani
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Riccardo Bariani
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giulia Mattesi
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Riccardo Vio
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Natascia Bettella
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Manuel DE Lazzari
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Raffaella Motta
- Unit of Radiology, Department of Medicine, Medical School, University of Padua, Padua, Italy
| | - Barbara Bauce
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alessandro Zorzi
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Domenico Corrado
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy -
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30
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Haqqani HM. Cardiac Sarcoidosis and Arrhythmogenic Cardiomyopathy. JACC Clin Electrophysiol 2020; 6:708-710. [DOI: 10.1016/j.jacep.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
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31
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Hoogendoorn JC, Sramko M, Venlet J, Siontis KC, Kumar S, Singh R, Nakajima I, Piers SR, de Riva Silva M, Glashan CA, Crawford T, Tedrow UB, Stevenson WG, Bogun F, Zeppenfeld K. Electroanatomical Voltage Mapping to Distinguish Right-Sided Cardiac Sarcoidosis From Arrhythmogenic Right Ventricular Cardiomyopathy. JACC Clin Electrophysiol 2020; 6:696-707. [DOI: 10.1016/j.jacep.2020.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/13/2020] [Accepted: 02/20/2020] [Indexed: 12/21/2022]
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32
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Kanagasundram A, John RM, Stevenson WG. Sustained Monomorphic Ventricular Tachycardia in Nonischemic Heart Disease. Circ Arrhythm Electrophysiol 2019; 12:e007312. [DOI: 10.1161/circep.119.007312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
As the population of patients with implanted defibrillators has grown, an increasing number of patients nonischemic cardiomyopathies are requiring therapy to reduce ventricular arrhythmias. Most of these arrhythmias are related to areas of ventricular scar. Although the pathophysiology of scar development is not well understood in these diseases, advances in cardiac imaging and mapping are better characterizing the scar locations that give rise to the arrhythmias. Here, we review the pathophysiologic and electrocardiographic correlations that inform ablation strategies for ventricular tachycardia in these diseases.
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Affiliation(s)
- Arvindh Kanagasundram
- The Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Roy M. John
- The Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - William G. Stevenson
- The Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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33
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Bière L, Piriou N, Ernande L, Rouzet F, Lairez O. Imaging of myocarditis and inflammatory cardiomyopathies. Arch Cardiovasc Dis 2019; 112:630-641. [PMID: 31494082 DOI: 10.1016/j.acvd.2019.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/23/2019] [Accepted: 05/27/2019] [Indexed: 12/11/2022]
Abstract
Myocarditis encompasses a wide range of myocardial inflammatory diseases, including acute myocarditis, chronic myocarditis and inflammatory cardiomyopathies, and myocardial inflammation associated with other cardiomyopathies. Because of this heterogeneity in clinical presentation, and the infrequent use of endomyocardial biopsy, cardiac imaging has gradually acquired a key role in the non-invasive detection of myocardial inflammation, the assessment of aetiology and the management of specific therapies. This article summarizes the issue of myocarditis and myocardial inflammation in clinical practice, and reviews the role of different non-invasive imaging techniques in the exploration of myocardial inflammation.
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Affiliation(s)
- Loïc Bière
- Department of cardiology, Angers university hospital, 49100 Angers, France
| | - Nicolas Piriou
- Department of nuclear medicine and Institut du Thorax, Nantes university hospital, 44000 Nantes, France
| | - Laura Ernande
- DHU ageing-thorax-vessel-blood, Henri-Mondor university hospital, AP-HP, 94010 Créteil, France
| | - François Rouzet
- Nuclear medicine department and DHU FIRE, Bichat-Claude Bernard hospital, AP-HP, 75877 Paris, France; Université de Paris, 75018 Paris, France; Inserm UMR 1148 and UMS 34, 75018 Paris, France
| | - Olivier Lairez
- Cardiac Imaging Centre, Rangueil university hospital, 31059 Toulouse, France.
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34
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Elliott PM, Anastasakis A, Asimaki A, Basso C, Bauce B, Brooke MA, Calkins H, Corrado D, Duru F, Green KJ, Judge DP, Kelsell D, Lambiase PD, McKenna WJ, Pilichou K, Protonotarios A, Saffitz JE, Syrris P, Tandri H, Te Riele A, Thiene G, Tsatsopoulou A, van Tintelen JP. Definition and treatment of arrhythmogenic cardiomyopathy: an updated expert panel report. Eur J Heart Fail 2019; 21:955-964. [PMID: 31210398 DOI: 10.1002/ejhf.1534] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/14/2019] [Accepted: 05/18/2019] [Indexed: 12/13/2022] Open
Abstract
It is 35 years since the first description of arrhythmogenic right ventricular cardiomyopathy (ARVC) and more than 20 years since the first reports establishing desmosomal gene mutations as a major cause of the disease. Early advances in the understanding of the clinical, pathological and genetic architecture of ARVC resulted in consensus diagnostic criteria, which proved to be sensitive but not entirely specific for the disease. In more recent years, clinical and genetic data from families and the recognition of a much broader spectrum of structural disorders affecting both ventricles and associated with a propensity to ventricular arrhythmia have raised many questions about pathogenesis, disease terminology and clinical management. In this paper, we present the conclusions of an expert round table that aimed to summarise the current state of the art in arrhythmogenic cardiomyopathies and to define future research priorities.
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Affiliation(s)
- Perry M Elliott
- University College London & St. Bartholomew's Hospital, London, UK
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Angeliki Asimaki
- Molecular and Clinical Sciences Research Institute, St Georges University, London, UK
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Padua, Italy
| | - Barbara Bauce
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Padua, Italy
| | - Matthew A Brooke
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Domenico Corrado
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Padua, Italy
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - Kathleen J Green
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel P Judge
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - David Kelsell
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Pier D Lambiase
- University College London & St. Bartholomew's Hospital, London, UK
| | - William J McKenna
- Institute of Cardiovascular Science, University College London, London, UK
| | - Kalliopi Pilichou
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Padua, Italy
| | | | - Jeffrey E Saffitz
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - Petros Syrris
- Institute of Cardiovascular Science, University College London, London, UK
| | - Hari Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anneline Te Riele
- Division of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Padua, Italy
| | | | - J Peter van Tintelen
- Department of Clinical Genetics, Amsterdam Cardiovascular Sciences, University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
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35
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Divakaran S, Stewart GC, Lakdawala NK, Padera RF, Zhou W, Desai AS, Givertz MM, Mehra MR, Kwong RY, Hedgire SS, Ghoshhajra BB, Taqueti VR, Skali H, Dorbala S, Blankstein R, Di Carli MF. Diagnostic Accuracy of Advanced Imaging in Cardiac Sarcoidosis. Circ Cardiovasc Imaging 2019; 12:e008975. [PMID: 31177817 DOI: 10.1161/circimaging.118.008975] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The diagnostic yield of cardiac sarcoidosis (CS) by endomyocardial biopsy is limited. Fluorodeoxyglucose (FDG) positron emission tomography (PET) and cardiac magnetic resonance imaging (MRI) may facilitate noninvasive diagnosis, but the accuracy of this approach is not well defined. We aimed to correlate findings from FDG PET and cardiac MRI with histological findings from explanted hearts of patients who underwent cardiac transplantation. Methods We analyzed the explanted heart histology for all patients who underwent cardiac transplant at our center from April 2008 to July 2018 and had pretransplant FDG PET (n=18) or cardiac MRI (n=31). The likelihood of CS based on FDG PET or cardiac MRI was categorized in a blinded fashion using a previously published method. RESULTS: Using a CS probable cutoff for FDG PET resulted in a sensitivity of 100.0% (95% CI, 54.1%-100.0%) and a specificity of 33.3% (95% CI, 9.9%-65.1%). Three of the 9 CS probable by FDG PET cases were found to be arrhythmogenic cardiomyopathy. The test characteristics of cardiac MRI are more challenging to comment on using our data as there was only one confirmed case of CS on post-transplant histological assessment. Of the 8 CS highly probable or probable cases by cardiac MRI, 3 were found to be dilated cardiomyopathy, and 2 were found to be end-stage hypertrophic cardiomyopathy. Conclusions FDG PET and cardiac MRI can help facilitate the diagnosis of CS in patients with advanced heart failure with a high degree of sensitivity but lower specificity.
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Affiliation(s)
- Sanjay Divakaran
- Cardiovascular Imaging Program, Departments of Medicine and Radiology (S.D., W.Z., R.Y.K., V.R.T., H.S., S.D., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Cardiovascular Division, Department of Medicine (S.D., G.C.S., N.K.L., A.S.D., M.M.G., M.R.M., R.Y.K., H.S., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Garrick C Stewart
- Cardiovascular Division, Department of Medicine (S.D., G.C.S., N.K.L., A.S.D., M.M.G., M.R.M., R.Y.K., H.S., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Neal K Lakdawala
- Cardiovascular Division, Department of Medicine (S.D., G.C.S., N.K.L., A.S.D., M.M.G., M.R.M., R.Y.K., H.S., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Robert F Padera
- Department of Pathology (R.F.P.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Wunan Zhou
- Cardiovascular Imaging Program, Departments of Medicine and Radiology (S.D., W.Z., R.Y.K., V.R.T., H.S., S.D., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Akshay S Desai
- Cardiovascular Division, Department of Medicine (S.D., G.C.S., N.K.L., A.S.D., M.M.G., M.R.M., R.Y.K., H.S., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael M Givertz
- Cardiovascular Division, Department of Medicine (S.D., G.C.S., N.K.L., A.S.D., M.M.G., M.R.M., R.Y.K., H.S., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mandeep R Mehra
- Cardiovascular Division, Department of Medicine (S.D., G.C.S., N.K.L., A.S.D., M.M.G., M.R.M., R.Y.K., H.S., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Raymond Y Kwong
- Cardiovascular Imaging Program, Departments of Medicine and Radiology (S.D., W.Z., R.Y.K., V.R.T., H.S., S.D., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Cardiovascular Division, Department of Medicine (S.D., G.C.S., N.K.L., A.S.D., M.M.G., M.R.M., R.Y.K., H.S., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sandeep S Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (S.S.H., B.B.G.)
| | - Brian B Ghoshhajra
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (S.S.H., B.B.G.)
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Medicine and Radiology (S.D., W.Z., R.Y.K., V.R.T., H.S., S.D., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Hicham Skali
- Cardiovascular Imaging Program, Departments of Medicine and Radiology (S.D., W.Z., R.Y.K., V.R.T., H.S., S.D., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Cardiovascular Division, Department of Medicine (S.D., G.C.S., N.K.L., A.S.D., M.M.G., M.R.M., R.Y.K., H.S., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology (S.D., W.Z., R.Y.K., V.R.T., H.S., S.D., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology (S.D., W.Z., R.Y.K., V.R.T., H.S., S.D., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Cardiovascular Division, Department of Medicine (S.D., G.C.S., N.K.L., A.S.D., M.M.G., M.R.M., R.Y.K., H.S., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology (S.D., W.Z., R.Y.K., V.R.T., H.S., S.D., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Cardiovascular Division, Department of Medicine (S.D., G.C.S., N.K.L., A.S.D., M.M.G., M.R.M., R.Y.K., H.S., R.B., M.F.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Amadu A, Baritussio A, Dastidar A, De Garate E, Rodrigues J, Biglino G, Lyen S, Diab I, Duncan E, Nisbet A, Thomas G, Angelini G, Bucciarelli-Ducci C. Arrhythmogenic right ventricular cardiomyopathy (ARVC) mimics: the knot unravelled by cardiovascular MRI. Clin Radiol 2019; 74:228-234. [DOI: 10.1016/j.crad.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
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Tsatsopoulou A, Bossone E. Common presentation of rare diseases: Arrhythmogenic right ventricular cardiomyopathy and its mimics. Int J Cardiol 2018; 257:371-377. [PMID: 29506736 DOI: 10.1016/j.ijcard.2018.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/04/2018] [Accepted: 01/11/2018] [Indexed: 02/07/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is the most common phenotype described within the spectrum of arrhythmogenic cardiomyopathies. It usually presents in early adolescence with severe ventricular arrhythmias along with cardiac structural and functional alterations mainly of the right ventricular myocardium. Though the estimated prevalence of ARVC in the general population is only 1:5000, it represents one of the most common causes of juvenile sudden death. However, detection of early RV dysfunction in ARVC may be challenging requiring high clinical suspicion and an algorithmic approach. A thorough family history of juvenile sudden death, ventricular arrhythmias and ICD implants should always be sought. Diagnosis usually requires electrocardiographic interpretation as well as cardiac imaging. In this article, the key diagnostic steps in the assessment of ARVC and diagnostic red flags that aid its differential diagnosis are discussed.
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39
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Sohn D, Park J, Lee S, Kim H, Kim Y. Viewpoints in the diagnosis and treatment of cardiac sarcoidosis: Proposed modification of current guidelines. Clin Cardiol 2018; 41:1386-1394. [PMID: 30144116 PMCID: PMC6490051 DOI: 10.1002/clc.23060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/15/2018] [Accepted: 08/21/2018] [Indexed: 12/17/2022] Open
Abstract
Isolated cardiac sarcoidosis is a generally accepted disease condition, and the low yield of endomyocardial biopsy because of patchy involvement is also well known. However, current guidelines still require histologic confirmation of granuloma for the diagnosis of cardiac sarcoidosis, either in myocardial or extra-cardiac tissues. Therefore, only a presumptive diagnosis of chronic multifocal myocarditis of unknown origin can be made in a large number of patients in whom the only considerable diagnosis is cardiac sarcoidosis based on current knowledge. Even if these patients are treated with the same treatment scheme as that for cardiac sarcoidosis, which may not cause harm in the absence of a definite diagnosis, the true spectrum of cardiac sarcoidosis could not be determined for deciding the optimal treatment strategy. In addition, the current recommendations for dose, duration of initial steroid therapy, and treatment in patients who did not respond to initial steroid therapy are not easy to follow in real-world practice. We would like to propose a scoring system for the diagnosis of cardiac sarcoidosis and suggest our adoption or modification of the diverse current recommendations.
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Affiliation(s)
- Dae‐Won Sohn
- Division of Cardiology, Department of Internal MedicineSeoul National University College of MedicineSeoulSouth Korea
| | - Jun‐Bean Park
- Division of Cardiology, Department of Internal MedicineSeoul National University College of MedicineSeoulSouth Korea
| | - Seung‐Pyo Lee
- Division of Cardiology, Department of Internal MedicineSeoul National University College of MedicineSeoulSouth Korea
| | - Hyung‐Kwan Kim
- Division of Cardiology, Department of Internal MedicineSeoul National University College of MedicineSeoulSouth Korea
| | - Yong‐Jin Kim
- Division of Cardiology, Department of Internal MedicineSeoul National University College of MedicineSeoulSouth Korea
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40
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Vaseghi M, Hu TY, Tung R, Vergara P, Frankel DS, Di Biase L, Tedrow UB, Gornbein JA, Yu R, Mathuria N, Nakahara S, Tzou WS, Sauer WH, Burkhardt JD, Tholakanahalli VN, Dickfeld TM, Weiss JP, Bunch TJ, Reddy M, Callans DJ, Lakkireddy DR, Natale A, Marchlinski FE, Stevenson WG, Della Bella P, Shivkumar K. Outcomes of Catheter Ablation of Ventricular Tachycardia Based on Etiology in Nonischemic Heart Disease: An International Ventricular Tachycardia Ablation Center Collaborative Study. JACC Clin Electrophysiol 2018; 4:1141-1150. [PMID: 30236386 PMCID: PMC6242273 DOI: 10.1016/j.jacep.2018.05.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/02/2018] [Accepted: 05/15/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This study sought to characterize ventricular tachycardia (VT) ablation outcomes across nonischemic cardiomyopathy (NICM) etiologies and adjust these outcomes by patient-related comorbidities that could explain differences in arrhythmia recurrence rates. BACKGROUND Outcomes of catheter ablation of VT in patients with NICM could be related to etiology of NICM. METHODS Data from 2,075 patients with structural heart disease referred for catheter ablation of VT from 12 international centers was retrospectively analyzed. Patient characteristics and outcomes were noted for the 6 most common NICM etiologies. Multivariable Cox proportional hazards modeling was used to adjust for potential confounders. RESULTS Of 780 NICM patients (57 ± 14 years of age, 18% women, left ventricular ejection fraction 37 ± 13%), underlying prevalence was 66% for dilated idiopathic cardiomyopathy (DICM), 13% for arrhythmogenic right ventricular cardiomyopathy (ARVC), 6% for valvular cardiomyopathy, 6% for myocarditis, 4% for hypertrophic cardiomyopathy, and 3% for sarcoidosis. One-year freedom from VT was 69%, and freedom from VT, heart transplantation, and death was 62%. On unadjusted competing risk analysis, VT ablation in ARVC demonstrated superior VT-free survival (82%) versus DICM (p ≤ 0.01). Valvular cardiomyopathy had the poorest unadjusted VT-free survival, at 47% (p < 0.01). After adjusting for comorbidities, including age, heart failure severity, ejection fraction, prior ablation, and antiarrhythmic medication use, myocarditis, ARVC, and DICM demonstrated similar outcomes, whereas hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis had the highest risk of VT recurrence. CONCLUSIONS Catheter ablation of VT in NICM is effective. Etiology of NICM is a significant predictor of outcomes, with ARVC, myocarditis, and DICM having similar but superior outcomes to hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis, after adjusting for potential covariates.
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Affiliation(s)
- Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California.
| | - Tiffany Y Hu
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | | | | | - David S Frankel
- Hospital of the University of Pennsylvania; Philadelphia, Pennsylvania
| | - Luigi Di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, Bronx, New York
| | | | - Jeffrey A Gornbein
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, California
| | - Ricky Yu
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | - Nilesh Mathuria
- Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, Texas
| | - Shiro Nakahara
- Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | | | | | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center; Austin, Texas
| | | | | | - J Peter Weiss
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - T Jared Bunch
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Madhu Reddy
- University of Kansas Medical Center, Kansas City, Kansas
| | - David J Callans
- Hospital of the University of Pennsylvania; Philadelphia, Pennsylvania
| | - Dhanunjaya R Lakkireddy
- Overland Park Regional Medical Center, HCA Midwest Health, Overland Park, Kansas City, Kansas
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center; Austin, Texas
| | | | | | | | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
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Waki H, Eguchi K, Toriumi S, Ikemoto T, Suzuki T, Fukushima N, Kario K. Isolated Cardiac Sarcoidosis Mimicking Arrhythmogenic Right Ventricular Cardiomyopathy. Intern Med 2018; 57:835-839. [PMID: 29225258 PMCID: PMC5891523 DOI: 10.2169/internalmedicine.9395-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/27/2017] [Indexed: 11/06/2022] Open
Abstract
The diagnosis of cardiac sarcoidosis (CS) has become easier due to advances in imaging modalities, but we sometimes encounter difficult-to-diagnose patients. We herein report the case of a 60-year-old Japanese woman who was diagnosed with isolated CS, although she also met the diagnostic criteria of arrhythmogenic right ventricular cardiomyopathy (ARVC). A histological examination by an endomyocardial biopsy of the right ventricle revealed the typical findings of granulomatous change for CS. Although she did not show any characteristics of systemic sarcoidosis, oral prednisolone treatment was introduced, and she achieved a good response. This case shows that the characteristics of CS can overlap with the diagnostic criteria of ARVC, and that a histological examination is essential for the correct diagnosis of CS.
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Affiliation(s)
- Hirotaka Waki
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Kazuo Eguchi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Shinichi Toriumi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Tomokazu Ikemoto
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Tsukasa Suzuki
- Department of Diagnostic Pathology, Jichi Medical University Hospital, Japan
| | - Noriyoshi Fukushima
- Department of Diagnostic Pathology, Jichi Medical University Hospital, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
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42
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Lee A, Mahadevan VS, Gerstenfeld EP. Iatrogenic atrial septal defect with right-to-left shunt following atrial fibrillation ablation in a patient with arrhythmogenic right ventricular cardiomyopathy. HeartRhythm Case Rep 2018; 4:159-162. [PMID: 29755946 PMCID: PMC5944033 DOI: 10.1016/j.hrcr.2017.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Adam Lee
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Vaikom S Mahadevan
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
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43
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Slart RHJA, Glaudemans AWJM, Lancellotti P, Hyafil F, Blankstein R, Schwartz RG, Jaber WA, Russell R, Gimelli A, Rouzet F, Hacker M, Gheysens O, Plein S, Miller EJ, Dorbala S, Donal E. A joint procedural position statement on imaging in cardiac sarcoidosis: from the Cardiovascular and Inflammation & Infection Committees of the European Association of Nuclear Medicine, the European Association of Cardiovascular Imaging, and the American Society of Nuclear Cardiology. J Nucl Cardiol 2018; 25:298-319. [PMID: 29043557 DOI: 10.1007/s12350-017-1043-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
- Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands.
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, GIGA-Cardiovascular Sciences, University Hospital Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Fabien Hyafil
- Department of Nuclear Medicine, Centre Hospitalier Universitaire Bichat, Département Hospitalo-Universitaire FIRE, Inserm 1148, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot, Paris, France
- Department of Nuclear Medicine Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ron Blankstein
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ronald G Schwartz
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Box 679, Rochester, NY, USA
- Nuclear Medicine Division, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Wael A Jaber
- Cleveland Clinic Lerner College of Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Raymond Russell
- Cardiovascular Institute, Rhode Island Hospital, Alpert School of Medicine of Brown University, Providence, RI, USA
| | | | - François Rouzet
- Department of Nuclear Medicine, Centre Hospitalier Universitaire Bichat, Département Hospitalo-Universitaire FIRE, Inserm 1148, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | - Olivier Gheysens
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Louvain, Belgium
- Department of Imaging and Pathology, KU Leuven, Louvain, Belgium
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Edward J Miller
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Erwan Donal
- Service de Cardiologie, et CIC-IT INSERM 1414, CHU Rennes, Rennes, France
- LTSI, Université de Rennes 1 - INSERM, UMR 1099, Rennes, France
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How to Evaluate for and Manage Inflammatory and Infiltrative Cardiomyopathies that Require Ventricular Tachycardia Ablation. CURRENT CARDIOVASCULAR RISK REPORTS 2017. [DOI: 10.1007/s12170-017-0563-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Marstrand P, Axelsson A, Thune JJ, Vejlstrup N, Pehrson S, Bundgaard H, Theilade J. Late potentials and their correlation with ventricular structure in patients with ventricular arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1466-1471. [PMID: 29090492 DOI: 10.1111/pace.13227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/03/2017] [Accepted: 10/16/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The presence of late potentials (LP) may indicate a predisposition to ventricular arrhythmias and sudden cardiac death. We investigated the association between presence of LP and structural cardiac anomalies assessed by magnetic resonance (CMR) in patients presenting with ventricular arrhythmias. METHODS We included 42 patients admitted with ventricular tachycardia or fibrillation who had undergone both signal-averaged ECG recording and CMR imaging. Clinical data and CMR findings were compared in patients with and without LP. RESULTS The majority, 26 (62%) patients, were sudden cardiac death survivors and the remaining 16 (38%) were admitted with ventricular tachycardia. After full diagnostic work-up, the most common diagnoses in the cohort were idiopathic ventricular tachycardia/ventricular fibrillation (25 patients, 60%) or cardiomyopathies (11 patients, 26%). LPs were positive in 29 (69%) when using the revised Task Force criteria. When comparing patients with and without late potentials, there were no significant differences in right ventricular size relative to body surface area (102 mL/m2 vs 92 mL/m2 ), right ventricular ejection fraction (55% vs 58%), or positive late gadolinium enhancement (29% vs 24%). CONCLUSIONS Among patients with malignant arrhythmias, the presence of LP does not distinguish between patients with normal and abnormal RV structure or function on CMR. LP may indicate the presence of an arrhythmic heart disease beyond what can be inferred from CMR. The frequent finding of late potentials indicates that the diagnostic value of LP as an ARVC criteria should be tested in larger studies comparing ARVC patients and controls.
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Affiliation(s)
- Peter Marstrand
- Department of Cardiology, Rigshospitalet, University Hospital Copenhagen, Denmark.,Department of Cardiology, Herlev-Gentofte Hospital, University Hospital Copenhagen, Denmark
| | - Anna Axelsson
- Department of Cardiology, Rigshospitalet, University Hospital Copenhagen, Denmark
| | - Jens Jakob Thune
- Department of Cardiology, Bispebjerg Hospital, University Hospital Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, University Hospital Copenhagen, Denmark
| | - Steen Pehrson
- Department of Cardiology, Rigshospitalet, University Hospital Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, University Hospital Copenhagen, Denmark
| | - Juliane Theilade
- Department of Cardiology, Herlev-Gentofte Hospital, University Hospital Copenhagen, Denmark
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Slart RHJA, Glaudemans AWJM, Lancellotti P, Hyafil F, Blankstein R, Schwartz RG, Jaber WA, Russell R, Gimelli A, Rouzet F, Hacker M, Gheysens O, Plein S, Miller EJ, Dorbala S, Donal E, Sciagra R, Bucerius J, Verberne HJ, Lindner O, Übleis C, Agostini D, Signore A, Edvardsen T, Neglia D, Beanlands RS, Di Carli M, Chareonthaitawee P, Dilsizian V, Soman P, Habib G, Delgado V, Cardim N, Cosyns B, Flachskampf F, Gerber B, Haugaa K, Lombardi M, Masci PG. A joint procedural position statement on imaging in cardiac sarcoidosis: from the Cardiovascular and Inflammation & Infection Committees of the European Association of Nuclear Medicine, the European Association of Cardiovascular Imaging, and the American Society of Nuclear Cardiology. Eur Heart J Cardiovasc Imaging 2017; 18:1073-1089. [DOI: 10.1093/ehjci/jex146] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/16/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, GIGA-Cardiovascular Sciences, University Hospital Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Fabien Hyafil
- Department of Nuclear Medicine, Centre Hospitalier Universitaire Bichat, Département Hospitalo-Universitaire FIRE, Inserm 1148, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot, Paris, France
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Ron Blankstein
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ronald G Schwartz
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Box 679, Rochester, NY, USA
- Nuclear Medicine Division, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Wael A Jaber
- Cleveland Clinic Lerner College of Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA
| | - Raymond Russell
- Cardiovascular Institute, Rhode Island Hospital, Alpert School of Medicine of Brown University, Providence, RI, USA
| | | | - François Rouzet
- Department of Nuclear Medicine, Centre Hospitalier Universitaire Bichat, Département Hospitalo-Universitaire FIRE, Inserm 1148, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | - Olivier Gheysens
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Belgium and Department of Imaging and Pathology, KU Leuven, Belgium
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Edward J Miller
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Erwan Donal
- Service de Cardiologie, et CIC-IT INSERM 1414, - CHU Rennes, - Rennes, France
- LTSI, Université de Rennes 1 - INSERM, UMR 1099, - Rennes, France
| | - Roberto Sciagra
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Jan Bucerius
- Department of Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Hein J Verberne
- Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Oliver Lindner
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - Christopher Übleis
- Department of Clinical Radiology, Ludwig-Maximilians Universität München, München, Germany
| | - Denis Agostini
- Department of Nuclear Medicine, CHU Cote de Nacre, CAEN, France
| | - Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, ‘Sapienza’ University of Roma, Rome, Italy
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | - Danilo Neglia
- Fondazione Toscana/CNR Gabriele Monasterio, Pisa, Italy
| | - Rob S Beanlands
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
| | - Marcelo Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Prem Soman
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, A-429 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Gilbert Habib
- Department of Cardiology, Aix-Marseille Université, Marseille 13284, France La Timone Hospital, 13005, Marseille, France
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Haugaa KH, Basso C, Badano LP, Bucciarelli-Ducci C, Cardim N, Gaemperli O, Galderisi M, Habib G, Knuuti J, Lancellotti P, McKenna W, Neglia D, Popescu BA, Edvardsen T. Comprehensive multi-modality imaging approach in arrhythmogenic cardiomyopathy-an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2017; 18:237-253. [PMID: 28069601 PMCID: PMC5837226 DOI: 10.1093/ehjci/jew229] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/03/2016] [Indexed: 12/29/2022] Open
Abstract
Arrhythmogenic cardiomyopathy (AC) is a progressive disease with high risk of life-threatening ventricular arrhythmias. A genetic mutation is found in up to 50-60% of probands, mostly affecting desmosomal genes. Diagnosis of AC is made by a combination of data from different modalities including imaging, electrocardiogram, Holter monitoring, family history, genetic testing, and tissue properties. Being a progressive cardiomyopathy, repeated cardiac imaging is needed in AC patients. Repeated imaging is important also for risk assessment of ventricular arrhythmias. This expert consensus document gives clinical recommendations for how to use multi-modality imaging in the different aspects of AC disease, including diagnosis, family screening, follow-up, risk assessment, and differential diagnosis.
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Affiliation(s)
- Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo and University of Oslo, Oslo, Norway
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luigi P Badano
- Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Chiara Bucciarelli-Ducci
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Trust and University of Bristol and Bristol NIRH Cardiovascular Biomedical Research Unit, Bristol, UK
| | - Nuno Cardim
- Department of Cardiology, Multimodality Cardiac Imaging Center, Sports Cardiology and Cardiomyopathies Center, Hospital da Luz, Lisbon, Portugal
| | - Oliver Gaemperli
- Interventional Cardiology and Cardiac Imaging, University Heart Center Zurich, Zurich, Switzerland
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Gilbert Habib
- Aix-Marseille Université, Marseille and Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu, Turku, Finland
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium and Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - William McKenna
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar and Imperial College, London, UK
| | - Danilo Neglia
- Cardiovascular Department at Fondazione Toscana G. Monasterio, CNR Institute of Clinical Physiology and Scuola Superiore San’Anna, Pisa, Italy
| | - Bogdan A Popescu
- University of Medicine and Pharmacy “Carol Davila”—Euroecolab, Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu,” Bucharest, Romania
| | - Thor Edvardsen
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo and University of Oslo, Oslo, Norway
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48
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Miller JM, Jain R, Dandamudi G, Kambur TR. Electrocardiographic Localization of Ventricular Tachycardia in Patients with Structural Heart Disease. Card Electrophysiol Clin 2016; 9:1-10. [PMID: 28167077 DOI: 10.1016/j.ccep.2016.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The 12-lead electrocardiogram (ECG) during ventricular tachycardia (VT) in patients with structural heart disease contains information that helps to narrow the electrophysiologist's search for target sites for ablation. Although replacement of myocardium by scar might be expected to produce variability in the spread of activation during VT, nonetheless reasonably consistent ECG patterns exist that can regionalize exit sites from VT circuits in up to 75% of cases. Most experience with this comes from patients with prior myocardial infarction, but a growing body of data exists concerning patients with nonischemic cardiomyopathies.
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Affiliation(s)
- John M Miller
- Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine, Indiana University, 1800 North Capitol Avenue, E-488, Indianapolis, IN 46202, USA.
| | - Rahul Jain
- Department of Medicine, Krannert Institute of Cardiology, Roudebush VA Medical Center, Indiana University School of Medicine, 1000 West 10th Street, Indianapolis, IN 46202, USA
| | - Gopi Dandamudi
- Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA
| | - Thomas R Kambur
- Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA
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Kawakatsu N, Suzuki A, Serizawa N, Suzuki T, Ejima K, Shiga T, Fukushima K, Momose M, Uto K, Shoda M, Hagiwara N. Isolated cardiac sarcoidosis diagnosed by electroanatomic voltage mapping-guided endomyocardial biopsy combined with magnetic resonance imaging and positron emission tomography. J Cardiol Cases 2016; 14:107-110. [PMID: 30524562 PMCID: PMC6262090 DOI: 10.1016/j.jccase.2016.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/21/2016] [Accepted: 06/02/2016] [Indexed: 11/15/2022] Open
Abstract
Cardiac involvement in sarcoidosis is related to lethal arrhythmias and is considered a serious condition. Because steroid therapy is an effective treatment, early diagnosis of cardiac sarcoidosis (CS) is of paramount importance in respect to improving prognosis. However, the diagnostic yield of histologic examination by endomyocardial biopsy (EMB) in CS is usually low. We report the case of isolated CS histopathologically proven by electroanatomical voltage mapping (EVM)-guided EMB combined with cardiac magnetic resonance imaging (CMR) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). A 53-year-old man presented with general fatigue. Electrocardiography showed intermittent complete atrioventricular block and echocardiography showed reduced cardiac function. CMR showed late gadolinium enhancement (LGE) in the areas of myocardium with suspected sarcoidosis. Next, we performed an EVM-guided EMB and found a non-caseating epithelioid granuloma in the right ventricular septum, which showed low voltage on EVM and LGE on CMR. FDG-PET showed accumulation in the same cardiac region. This case shows that EVM-guided EMB combined with diagnostic imaging can be a valuable approach in cases of suspected isolated CS. .
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Affiliation(s)
- Naomi Kawakatsu
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Naoki Serizawa
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsuyoshi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Ejima
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Fukushima
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Mitsuru Momose
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenta Uto
- Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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50
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Akdis D, Brunckhorst C, Duru F, Saguner AM. Arrhythmogenic Cardiomyopathy: Electrical and Structural Phenotypes. Arrhythm Electrophysiol Rev 2016; 5:90-101. [PMID: 27617087 PMCID: PMC5013177 DOI: 10.15420/aer.2016.4.3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 08/03/2016] [Indexed: 12/12/2022] Open
Abstract
This overview gives an update on the molecular mechanisms, clinical manifestations, diagnosis and therapy of arrhythmogenic cardiomyopathy (ACM). ACM is mostly hereditary and associated with mutations in genes encoding proteins of the intercalated disc. Three subtypes have been proposed: the classical right-dominant subtype generally referred to as ARVC/D, biventricular forms with early biventricular involvement and left-dominant subtypes with predominant LV involvement. Typical symptoms include palpitations, arrhythmic (pre)syncope and sudden cardiac arrest due to ventricular arrhythmias, which typically occur in athletes. At later stages, heart failure may occur. Diagnosis is established with the 2010 Task Force Criteria (TFC). Modern imaging tools are crucial for ACM diagnosis, including both echocardiography and cardiac magnetic resonance imaging for detecting functional and structural alternations. Of note, structural findings often become visible after electrical alterations, such as premature ventricular beats, ventricular fibrillation (VF) and ventricular tachycardia (VT). 12-lead ECG is important to assess for depolarisation and repolarisation abnormalities, including T-wave inversions as the most common ECG abnormality. Family history and the detection of causative mutations, mostly affecting the desmosome, have been incorporated in the TFC, and stress the importance of cascade family screening. Differential diagnoses include idiopathic right ventricular outflow tract (RVOT) VT, sarcoidosis, congenital heart disease, myocarditis, dilated cardiomyopathy, athlete's heart, Brugada syndrome and RV infarction. Therapeutic strategies include restriction from endurance and competitive sports, β-blockers, antiarrhythmic drugs, heart failure medication, implantable cardioverter-defibrillators and endocardial/epicardial catheter ablation.
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Affiliation(s)
- Deniz Akdis
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | | | - Firat Duru
- Department of Cardiology, University Heart Center, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, Zurich, Switzerland
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