Catheter ablation of atrial arrhythmias in cardiac sarcoidosis

Ablation of Atrial Arrhythmias in Cardiac Sarcoidosis. Background:We previously reported on the incidence and clinical implications of supraventricular arrhythmia in patients with cardiac sarcoidosis (CS). The role of catheter ablation for the management of atrial arrhythmia (AA) in this patient population is unknown.

Methods and Results: One hundred consecutive patients with CS were monitored for the incidence of supraventricular arrhythmias. Those with persistent symptoms despite optimal medical therapy proceeded to catheter ablation. Following ablation, all patients were followed serially with Holter monitoring or device interrogation. Thirty-two (32%) patients had symptomatic supraventricular arrhythmias. Nine (28%) patients had symptomatic AA requiring catheter ablation for clinical indications. Mean age was 55 ± 11.6 years. Five (56%) patients had atrial fibrillation (AF), of whom 2 also had cavotricuspid isthmus ablation. Four patients had isolated atrial flutter: 2 patients with left atrial flutter, and 2 patients with cavotricuspid flutter. All other arrhythmias were ablated in the left atrium. Mean duration of follow-up was 1.8 ± 1.9 years. One patient with atypical atrial flutter, and one patient with AF have had recurrence; the remaining patients remain in sinus rhythm.

Conclusions: Our study suggests that AA in CS is frequently left atrial in origin. Catheter ablation appears to be effective and safe for the maintenance of sinus rhythm in patients with CS.