CONGRESS ABSTRACT

Sarcoidosis is a multisystem inflammatory disease characterized by the formation of non-caseating granulomas. Cardiac involvement occurs in 5-10% of cases but is often underdiagnosed due to its variable presentation, ranging from asymptomatic cases to fatal arrhythmias and sudden cardiac death. We report the case of a patient with cardiac sarcoidosis. A 52-year-old woman presented with progressive dyspnea. Chest CT revealed multiple lesions suggestive of pulmonary sarcoidosis. A 24-hour Holter ECG showed frequent ventricular ectopic beats, couplets, and short runs of polymorphic non-sustained ventricular tachycardia (NSVT). Given the suspicion of cardiac involvement, a PET-CT scan confirmed pathological myocardial uptake, indicating active inflammation. The patient was started on immunosuppressive therapy with corticosteroids and disease-specific treatment. After six months, a follow-up PET-CT scan showed no abnormal cardiac uptake, suggesting resolution of the active inflammatory process. However, a repeat Holter ECG continued to show ventricular ectopy with occasional polymorphic couplets and triplets. To further evaluate the cardiac substrate, a cardiac magnetic resonance (CMR) scan was performed, revealing extensive late gadolinium enhancement (LGE) consistent with ongoing myocardial inflammation and fibrosis. Beta-blockers were titrated to the maximum tolerated dose alongside continued sarcoidosis therapy. Despite partial improvement, the persistence of ventricular arrhythmias prompted an electrophysiological study, which demonstrated easy inducibility of malignant ventricular arrhythmias. Due to the high risk of sudden cardiac death, an implantable cardioverter-defibrillator (ICD) was placed as a primary prevention measure. This case underscores the importance of a comprehensive diagnostic approach in suspected cardiac sarcoidosis. The integration of PET-CT and CMR enabled precise assessment of myocardial inflammation and fibrosis. Although antiarrhythmic therapy and immunosuppressive treatment improved arrhythmia burden, the electrophysiological study confirmed a persistent arrhythmic substrate requiring ICD implantation.  Cardiac sarcoidosis is a potentially life-threatening condition that requires early detection and a tailored management strategy. Multimodal imaging, electrophysiological evaluation, and timely device implantation are essential in managing high-risk patients, improving prognosis and reducing the risk of sudden cardiac death.