Bidirectional ventricular tachycardia in cardiac sarcoidosis

Mina M. Benjamin, MD; Kevin Hayes, MD; Michael E. Field, MD; Melvin M. Scheinman, MD; Kurt S. Hoffmayer, MD

doi:10.1016/j.joa.2016.05.003

Journal of Arrhythmia (Feb 2017)

Bidirectional ventricular tachycardia in cardiac sarcoidosis

Mina M. Benjamin, MD,
Kevin Hayes, MD,
Michael E. Field, MD,
Melvin M. Scheinman, MD,
Kurt S. Hoffmayer, MD

Affiliations

Mina M. Benjamin, MD: Department of Internal Medicine (Division of Cardiology), University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53713, United States
Kevin Hayes, MD: Department of Internal Medicine (Division of Cardiology), University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53713, United States
Michael E. Field, MD: Department of Internal Medicine (Division of Cardiology), University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53713, United States
Melvin M. Scheinman, MD: Department of Internal Medicine (Division of Cardiology), University of California in San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, United States
Kurt S. Hoffmayer, MD: Department of Internal Medicine (Division of Cardiology), University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53713, United States

DOI: https://doi.org/10.1016/j.joa.2016.05.003
Journal volume & issue: Vol. 33, no. 1
pp. 69 – 72

Abstract

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A 73-year-old man with history of pulmonary sarcoidosis was found to have runs of non-sustained bidirectional ventricular tachycardia (BVT) with two different QRS morphologies on a Holter monitor. Cardiac magnetic resonance delayed gadolinium imaging revealed a region of patchy mid-myocardial enhancement within the left ventricular basal inferolateral myocardium. An 18-fluorodeoxyglucose positron emission tomography (FDG-PET) showed increased uptake in the same area, consistent with active sarcoid, with no septal involvement. Follow-up FDG-PET one year later showed disease progression with new septal involvement. Cardiac sarcoidosis, characterized by myocardial inflammation and interstitial fibrosis that can lead to conduction system disturbance and macro re-entrant arrhythmias, should be considered in differential diagnosis of BVT. BVT may indicate septal involvement with sarcoidosis before the lesions are large enough to be detected radiologically.

Published in Journal of Arrhythmia

ISSN: 1880-4276 (Print); 1883-2148 (Online)
Publisher: Wiley
Country of publisher: Australia
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://onlinelibrary.wiley.com/journal/18832148

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Abstract

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