Treatment of Ventricular Arrhythmias in Cardiac Sarcoidosis with Both Immunosuppression and Antiarrhythmics

Background: Immunosuppression and antiarrhythmics can be useful for the treatment of arrhythmias in cardiac sarcoidosis (CS). The current evidence on the efficacy of corticosteroid sparing agents for arrhythmias is limited, and the optimal timing for initiation of antiarrhythmic therapy is unknown. Objective: To assess the impact of corticosteroid sparing immunosuppression with and without antiarrhythmics on arrhythmia burdens in CS. Methods: Patients with CS and implanted cardiac devices were identified from a single center sarcoidosis registry. The patients' medical regimens were grouped as no therapy, immunosuppression alone, antiarrhythmic alone, or dual therapy. Device interrogations were reviewed for premature ventricular contractions (PVCs), nonsustained ventricular tachycardia (NSVT), and appropriate device firing. Results: Interrogations for 42 patients were reviewed over a mean of 31 months. Regression analysis showed a significant decrease in the PVC (slope -1.47, p=0.04) and NSVT frequency (slope -0.05, p=.01) for patients on dual therapy compared to an increase or no change in the other groups. Across all patients, there was no difference between groups in the percentage of patients experiencing device firing. In a subset analysis of patients with ICDs for primary prevention, 6% on dual therapy required device firing compared to 43% and 40% on single or no therapy (P=.049, Chi Sq=6.02). Conclusions: Patients on both immunosuppression and antiarrhythmics had a reduction in PVCs and NSVT over time. Those with devices placed for primary prevention experienced fewer device firings while on dual therapy.