SARCOIDOSIS

In regards to making the diagnosis of cardiac sarcoidosis, if we apply the 2006
Japanese guidelines (Japanese Society of Sarcoidosis and Other Granulamous
Disorders)..... [the diagnosis of cardiac sarcoidosis was made by"

                (a) Histological Diagnosis (tissue biopsy)
                (b) Clinical diagnosis of extracardiac sarcoidosis + Major and
                    minor criteria:  (3 majors) or (1 major + 3 minor)

        -Major criteria include:
                (a) Advanced AV Block
                (b) Basal thinning of the IV septum
                (c) Cardiac Gallium Uptake
                (d) LVEF < 50%

        -Minor criteria include:
                (a) Abnormal ECG findings
                        -PVCs or VT
                        -RBBB
                        -Axis Deviation
                        -Abnormal Q waves
                (b) Abnormal Echo findings
                        -Regional Wall motion abnormalities
                (c) Perfusion defect detected by thallium or technetium
                    scintigraphy
                (e) Late gadolinium enhancement on cMRI
                (f) More than moderate monocyte infiltration or interstitial
                    fibrosis on endomyocardial biopsy

        -Our patient has ... Major Criteria  and
        major criteria...  Thus, he has
        fulfilled the diagnosic criteria for Cardiac Sarcoidosis

        -As he now meets criteria for Cardiac Sarcoidosis, then we can apply the
        2014 HRS Expert Consensus Statement on the Diagnosis and Management of
        Arrhythmias Associated with Cardiac Sarcoidosis  (Heart Rhythm,Vol
        11,No7, July 2014).  

      By the guidelines, it is a class IIa indication
        for ICD implantation in patients with cardiac sarcoidosis, independent
        of ventricular function, and one or more of the following:
                (1) An indication for permanent pacemaker implantation
                (2) Unexplained syncope or near-syncope, felt to be arrhythmic
                    in etiology
                (3) Inducible sustained ventricular arrhythmia