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J Arrhythm. 2017 Feb;33(1):69-72. doi: 10.1016/j.joa.2016.05.003. Epub 2016 Jun 4.

Bidirectional ventricular tachycardia in cardiac sarcoidosis.

Author information

1
Department of Internal Medicine (Division of Cardiology), University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53713, United States.
2
Department of Internal Medicine (Division of Cardiology), University of California in San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, United States.

Abstract

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.

KEYWORDS:

Arrhythmias; BVT, Bidirectional ventricular tachycardia; Cardiac sarcoidosis; ICD, Implantable cardioverter defibrillator; Magnetic resonance tomography; PET, Positron emission tomography; PVC, Premature ventricular contraction; Positron emission tomography; VT, Ventricular tachycardia.; Ventricular tachycardia

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