2017 Volume 3 Issue 1 Pages 131-136
Approximately 5% of patients with sarcoidosis will have cardiac involvement clinically manifest as one or more of ventricular arrhythmias, conduction abnormalities and heart failure. Another 20% to 25% have clinically silent disease (asymptomatic cardiac involvement). There is a growing realisation that CS can be the first manifestation of sarcoidosis in any organ. In particular physicians should consider CS in patients with VT of unknown etiology and in patients aged <60 presenting with idiopathic advanced conduction system disease. Immunosuppression therapy (usually with corticosteroids) has been suggested for the treatment of clinically manifest CS despite modest data. Positron Emission Tomography (FDG-PET) imaging is often used to detect active disease and guide immunosuppression. The extent of left ventricular dysfunction seems to be the most important predictor of prognosis. Also the extent of LGE on CMR is emerging as an important prognostic factor. Patients with clinically manifest disease often need device therapy, usually with implantable cardioverter defibrillators. There are still much to be learned as regarding best practices in managing CS patients and multi-center research efforts are underway.