Programmed electrical stimulation could help guide use of ICDs in patients with sarcoidosis

Mehta D. Circ Arrhythm Electrophysiol. 2010;doi:10.1161/CIRCEP.110.958322.

New data have shown that programmed electrical stimulation may be beneficial as a tool in risk stratification of patients with cardiac sarcoidosis and may also help guide the use of implantable cardioverter defibrillators in this population.

Researchers included 76 patients in the analysis, 56.6% of whom were women. All patients had a diagnosis of sarcoidosis and were referred to an electrophysiologist for risk stratification between June 1998 and June 2008. Patients were excluded if they had a history of ICD implantation or ventricular arrhythmia, and only those who consented to programmed electrical stimulation of the ventricle (PES) were included.

During PES, eight of the patients were inducible for sustained ventricular arrhythmia and placed in the positive PES group and received an ICD. The remaining 68 patients were placed in the negative PES group and did not receive an ICD.

Researchers reported that compared with the negative PES group, the mean left ventricular ejection fraction in the positive PES group was significantly lower at the time of PES (P=.0119) and at 1 (P=.0151) and 2 (P=.0356) years. The event rate in the positive PES group was 75%, whereas it was 1.5% in the negative PES group (P<.0001). The survival rate also significantly favored the negative PES group (P<.0001).

“A positive PES may help to identify those at risk for ventricular arrhythmia who thus would benefit from a primary prevention ICD. More importantly, patients in this cohort with a negative PES appear to have a benign course within the first several years following diagnosis,” the researchers concluded. “Larger prospective studies are needed to determine how ICD therapy should be optimally prescribed in this population.”

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