Abstract 8559: Efficacy of Implantable Cardiac Defibrillators for the Prevention of Sudden Cardiac Death in Patients with Cardiac Sarcoidosis

• Published in: Circulation (New York, N.Y.) Vol. 124; no. suppl_21
• Main Authors: Kron, Jordana, Bogun, Frank M, Crawford, Thomas C, Sarsam, Sinan H, Mehta, Davendra, Greenspon, Arnold J, Ortman, Matthew, DeLurgio, David B, Valadri, Ravinder R, Narasimhan, Calambur, Nalla, Swapna, Singh, Jagmeet P, Danik, Stephan B, Benditt, David G, Almquist, Adrian K, Krahn, Andrew D, Cooper, Joshua M, Markowitz, Steven M, Morales, Jacquelene, Wolfe, Luke G, Feinstein, Shawn D, Ellenbogen, Kenneth A
• Format: Journal Article
• Language: English
• Published: 22-11-2011
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.124.suppl_21.A8559

Abstract only
Introduction
Patients with cardiac sarcoidosis (CS) are at increased risk for sudden death from ventricular arrhythmias. There is little evidence regarding the efficacy and safety of implantable cardiac defibrillators (ICDs) in this population.
Hypothesis
Data on demographic, clinical, and ICD intervention history was retrospectively collected on 138 CS patients with ICDs from 11 academic centers throughout the U.S., Canada, and India. We hypothesized that patients with CS would have a high incidence of appropriate ICD therapies.
Results
Sixty-two of 138 CS patients (44.92%) had an appropriate ICD therapy (ATP or shock) with 39 patients (28.3%) receiving 5 or more therapies (Figure). Forty-eight of 131 patients (36.64%) received an appropriate shock. Thirty-seven of 136 patients (27.21%) had an inappropriate shock. The incidence of appropriate therapy (ATP or shock) was 10.4%/year and the incidence of appropriate shock was 8.5%/year. Twenty-two patients (15.9%) experienced an adverse event, the most common being lead dislodgement in 11 patients (8%). Appropriate therapies (ATP or shock) were more common in patients with syncope 24/37 (65%) versus patients who did not have syncope 38/101 (38%) (p = 0.0065). Appropriate therapies were more common in patients who had ventricular pacing on baseline EKG, 9/10 (90%), compared with those who did not, 53/128 (41%) (p=0.0053). The mean age of patients who received an appropriate therapy (n=59) was 51.7 ± 11.6 compared with 56.9 ± 10.2 for those who did not receive appropriate therapy (n=74) (p = 0.0066). Immunosuppressive medications including steroids, methotrexate, azathioprine, and hydroxychloroquine were not associated with reduced number of appropriate therapies.
Conclusions
Patients with CS have high rates of appropriate ICD therapies. This population also has high rates of inappropriate shocks and adverse events. Syncope, ventricular pacing, and younger age may identify the highest risk CS patients.