Ventricular Tachycardia in Cardiac Sarcoidosis Controlled by Radiofrequency Catheter Ablation

Mika Bando, Takeshi Soeki, Toshiyuki Niki, Kenya Kusunose, Noriko Tomita, Koji Yamaguchi, Kunihiko Koshiba, Yoshio Taketani, Takashi Iwase, Hirotsugu Yamada, Tetsuzo Wakatsuki, Masashi Akaike (+1 others)
2011 Internal medicine (Tokyo. 1992)  
We report a case of a 78-year-old woman with cardiac sarcoidosis with a history of syncope and palpitation. Further assessment with echocardiography, gadolinium-enhanced cardiovascular magnetic resonance (CMR) and histology led to a diagnosis of cardiac sarcoidosis. As the patient suffered from ventricular tachycardia (VT) despite active corticosteroid therapy, an implantable cardioverter-defibrillator (ICD) was positioned. She was also administered a beta blocker, but an electrical storm
more » ... ctrical storm appeared every several days requiring ICD therapy. The drug-refractory VT was finally controlled with a catheter ablation session, during which we could detect the VT focus in the right ventricular outflow tract next to the aneurysm by using an electroanatomic mapping system (CARTO). Referring to echocardiographic and CMR images proved very useful in detecting the aneurysm using the CARTO system. A 78-year-old woman presented to our hospital with a complaint of recurrent syncopal episodes. She had a history of chronic bronchitis and had received outpatient treatment at a nearby clinic for years. She had neither coronary risk factors nor a family history of cardiac diseases. Two years prior to presentation, she experienced loss of consciousness for the first time. An initial electrocardiogram at a nearby hospital revealed complete right bundle branch block and left anterior fascicular block, but neither ischemic ST-T changes nor critical arrhythmias were observed (Fig. 1A) . Chest X-ray showed a small bilateral pleural effusion. She also complained of myalgia that continued for months, and
doi:10.2169/internalmedicine.50.4580 pmid:21628935 fatcat:nzeudadgajamhoylamfzj56oem