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Heart Disease (Expert Forum)
Myocardial Sarcoidodsis Complete Heart Block
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
Myocardial Sarcoidodsis Complete Heart Block
by DA-Smith, Jul 18, 1999 12:00AM
Posted by D.A. Smith on July 18, 1999 at 14:49:52
Might Radiofrequency ablation be used to mitigate arrythmias caused by sarcoidosis? I received a Medtronic ICD implant in January 1999 due to myocardial sarcoidosis. I maintain a very healthy diet and resumed normal physical activities, including intense cycling, within weeks after the surgery. Through prednisone usage, nearly all granulomas have apparently (suprisingly) been eliminated as evidenced from results of the most recent gallium scan in June which showed no signs of cardiac sarcoids. My ICD is programmed to pace my sinal-atrial signal below 120 bpm and to allow functioning of my natural (although a little slow) heart rhythm between 120-150 bpm. Due to my fitness level, its extremely difficult to keep my heart rate during exercise below 150 bpm, the rate at which the defibrillator starts activation, especially in warm humid weather. The problem is that the ICD is unable to clearly distinquish my normal AV signal above 150 bpm during exercise from dangerous tachycardia, a painfully shocking experience I try to avoid. I'm taking 400 mg/day amiodarone and 50 mg/day metoprolol to control tachycardia activity but I'd rather not increase the dosage of these medications. Also these medications are unacceptable for long term usage and I'd rather avoid getting a heart transplant later unless absolutely neccesary. Is Radiofrequency ablation or some other medical procedure a possible solution to solve ICD/tachycardia problems in this case?
Also, since the sarcoid granulomas have effectly been eliminated, why do I still have heart block? Does cardiac sarcoidosis normally permanently disrupt AV signals, and if so how?
Posted by CCF CARDIO MD - CRC on July 19, 1999 at 10:03:47
Usually cardiac sarcoidosis is a diffuse process and this is the main problem with ablation therapy. If the source of VT could be mapped it's possible to ablate it but it may not be possible to map it to one site. The damage to the conduction system is due to fibrosis of the tissue and is not usually reversible. It may be possible to have the ventricular tachycardia detect rate turned higher (unless you have a very slow VT) and this would allow a more enjoyable work-out.
I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
