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Chapter-34 Ventricular Tachycardia in Specific Cardiomyopathies: Sarcoidosis and Tuberculosis

BOOK TITLE: Practical Cardiac Electrophysiology

Author
1. Saggu Daljeet Kaur
2. Narasimhan Calambur
ISBN
9789386056795
DOI
10.5005/jp/books/13028_35
Edition
1/e
Publishing Year
2017
Pages
10
Author Affiliations
1. CARE Hospital, Hyderabad, Telangana, India, CARE Hospitals, Hyderabad, Telangana, India, AIG Hospital, Hyderabad, Telangana, India
2. CARE Hospital, Hyderabad, Telangana, India
Chapter keywords
Ventricular tachycardia, cardiomyopathies, sarcoidosis, tuberculosis, granulomatous myocarditis, GM, tissue biopsy, antiarrhythmic drug therapy

Abstract

Cardiomyopathy due to granulomatous myocarditis (GM) because of sarcoidosis or tuberculosis is an under-recognized entity. Ventricular tachycardia (VT) with or without ventricular systolic dysfunction may be the presenting feature of GM. Sarcoidosis is a multisystem disease of unknown etiology characterized by histopathological finding of noncaseating granulomas and subsequent scarring. Cardiac sarcoidosis is associated with a mortality rate exceeding 40% at 5 years. Cardiac tuberculosis (CTB) is another important cause of GM and is considered to be rare. Clinical presentation of CTB mimics that of cardiac sarcoidosis and has a poor prognosis if not diagnosed and treated promptly. The diagnosis of GM can be challenging and may involve various investigations involving imaging, histopathology, microbiology and immunology. Tuberculin skin test, cardiac imaging, tissue biopsy and histopathological diagnosis are the different tests used for the diagnosis of GM. Medical therapy of GM is ineffective in approximately 50% of these patients and catheter ablation is a viable therapeutic option in selected patients with recurrent VT episodes. Disease-specific and antiarrhythmic drug therapy, catheter ablation in cardiac sarcoidosis and tuberculosis, and implantable cardioverter-defibrillator (ICD) implantation are other treatment options for GM are discussed in this chapter in detail.

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