We reviewed a total of 202 patients who...

We reviewed a total of 202 patients who were implanted with a CRT-P or CRT-D device on the basis of the guidelines. Of those, we found 20 (9.9%) patients who were diagnosed with cardiac sarcoidosis (Figure 1). Two patients were excluded because of a loss to follow-up. We thus finally analysed 18 (8.9%) patients with cardiac sarcoidosis. Table 1 shows the clinical characteristics of the patients at the time of the CRT implantation. The vast majority of the patients were female [15 (83.3%)], were previously diagnosed with advanced atrioventricular block [14 (77.8%)], and had a clinical diagnosis of cardiac sarcoidosis [15 (83.3%)]. Among 15 patients with a clinical diagnosis, 10 patients were diagnosed with extracardiac sarcoidosis by a lung biopsy, 3 by a lymph node biopsy, 1 by a skin biopsy, and 1 by a conjunctiva biopsy. We found 9 (50%) and 13 (72.2%) patients who received corticosteroids and amiodarone, respectively. Ten (55.6%) patients received a CRT-D, and of those, 9 were implanted with it for the purpose of secondary prevention of arrhythmic mortality (Table 1). Only one patient had longstanding persistent atrial fibrillation with a slow ventricular response. All the patients studied had a biventricular pacing percentage of >90%.

Table 1

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Clinical characteristics of the patients at the CRT implantation

Patient no.	Age (year)	Female	NYHA	Histologic diagnosis^a	Upgrade or de novo	QRS morphology	QRS width (ms)	LVEF (%)	LVEDV (mL)	LVESV (mL)	Beta-blocker	ACE-I or ARB	Corticosteroid	Amiodarone
1	66	Yes	Class III	No	Upgrade from a PM to CRT-P	Paced LBBB	200	18	270	220	Yes	Yes	Yes	No
2	67	Yes	Class III	No	Upgrade from a PM to CRT-P	Paced LBBB	200	10	244	218	No	No	No	No
3	61	Yes	Class IV	No	Upgrade from a PM to CRT-D	Paced LBBB	212	23	282	216	Yes	Yes	No	Yes
4	69	Yes	Class III	No	Upgrade from a PM to CRT-P	Paced LBBB	180	30	208	144	No	Yes	Yes	Yes
5	67	Yes	Class III	No	Upgrade from a PM to CRT-D	Paced LBBB	200	25	253	190	Yes	Yes	No	Yes
6	71	Yes	Class III	Yes	Upgrade from a PM to CRT-P	Paced LBBB	206	31	331	227	Yes	Yes	Yes	No
7	74	Yes	Class III	No	De novo CRT-P	Intrinsic LBBB	194	28	210	151	No	Yes	No	Yes
8	63	Yes	Class II	No	Upgrade from a PM to CRT-P	Paced LBBB	138	33	144	96	Yes	Yes	No	Yes
9	54	Yes	Class III	No	Upgrade from an ICD to CRT-D	Paced LBBB	160	23	292	224	No	No	No	Yes
10	72	Yes	Class III	No	Upgrade from a PM to CRT-P	Paced LBBB	262	21	255	201	Yes	Yes	No	No
11	64	No	Class IV	No	De novo CRT-D	Intrinsic LBBB	132	11	180	160	Yes	Yes	No	Yes
12	64	Yes	Class III	No	Upgrade from a PM to CRT-D	Paced LBBB	200	35	167	108	Yes	Yes	Yes	Yes
13	56	Yes	Class III	No	Upgrade from a PM to CRT-D	Intrinsic RBBB	152	34	233	154	Yes	Yes	Yes	No
14	76	Yes	Class III	Yes	Upgrade from a PM to CRT-P	Paced LBBB	248	29	335	239	Yes	Yes	Yes	Yes
15	68	Yes	Class III	No	De novo CRT-D	Intrinsic LBBB	140	30	154	108	Yes	Yes	No	Yes
16	35	No	Class II	Yes	Upgrade from a PM to CRT-D	Paced LBBB	190	19	231	187	Yes	Yes	Yes	Yes
17	70	Yes	Class III	No	De novo CRT-D	Intrinsic RBBB	164	20	135	108	Yes	Yes	Yes	Yes
18	75	No	Class III	No	De novo CRT-D	Intrinsic LBBB	147	23	216	167	Yes	Yes	Yes	Yes
Mean ± SD or %	65 ± 10	83.3	N/A	16.7	N/A	N/A	185 ± 37	24 ± 6	230 ± 60	173 ± 47	77.8	88.9	50	72.2

Patient no.	Age (year)	Female	NYHA	Histologic diagnosis^a	Upgrade or de novo	QRS morphology	QRS width (ms)	LVEF (%)	LVEDV (mL)	LVESV (mL)	Beta-blocker	ACE-I or ARB	Corticosteroid	Amiodarone
1	66	Yes	Class III	No	Upgrade from a PM to CRT-P	Paced LBBB	200	18	270	220	Yes	Yes	Yes	No
2	67	Yes	Class III	No	Upgrade from a PM to CRT-P	Paced LBBB	200	10	244	218	No	No	No	No
3	61	Yes	Class IV	No	Upgrade from a PM to CRT-D	Paced LBBB	212	23	282	216	Yes	Yes	No	Yes
4	69	Yes	Class III	No	Upgrade from a PM to CRT-P	Paced LBBB	180	30	208	144	No	Yes	Yes	Yes
5	67	Yes	Class III	No	Upgrade from a PM to CRT-D	Paced LBBB	200	25	253	190	Yes	Yes	No	Yes
6	71	Yes	Class III	Yes	Upgrade from a PM to CRT-P	Paced LBBB	206	31	331	227	Yes	Yes	Yes	No
7	74	Yes	Class III	No	De novo CRT-P	Intrinsic LBBB	194	28	210	151	No	Yes	No	Yes
8	63	Yes	Class II	No	Upgrade from a PM to CRT-P	Paced LBBB	138	33	144	96	Yes	Yes	No	Yes
9	54	Yes	Class III	No	Upgrade from an ICD to CRT-D	Paced LBBB	160	23	292	224	No	No	No	Yes
10	72	Yes	Class III	No	Upgrade from a PM to CRT-P	Paced LBBB	262	21	255	201	Yes	Yes	No	No
11	64	No	Class IV	No	De novo CRT-D	Intrinsic LBBB	132	11	180	160	Yes	Yes	No	Yes
12	64	Yes	Class III	No	Upgrade from a PM to CRT-D	Paced LBBB	200	35	167	108	Yes	Yes	Yes	Yes
13	56	Yes	Class III	No	Upgrade from a PM to CRT-D	Intrinsic RBBB	152	34	233	154	Yes	Yes	Yes	No
14	76	Yes	Class III	Yes	Upgrade from a PM to CRT-P	Paced LBBB	248	29	335	239	Yes	Yes	Yes	Yes
15	68	Yes	Class III	No	De novo CRT-D	Intrinsic LBBB	140	30	154	108	Yes	Yes	No	Yes
16	35	No	Class II	Yes	Upgrade from a PM to CRT-D	Paced LBBB	190	19	231	187	Yes	Yes	Yes	Yes
17	70	Yes	Class III	No	De novo CRT-D	Intrinsic RBBB	164	20	135	108	Yes	Yes	Yes	Yes
18	75	No	Class III	No	De novo CRT-D	Intrinsic LBBB	147	23	216	167	Yes	Yes	Yes	Yes
Mean ± SD or %	65 ± 10	83.3	N/A	16.7	N/A	N/A	185 ± 37	24 ± 6	230 ± 60	173 ± 47	77.8	88.9	50	72.2

CRT, cardiac resynchronization therapy; NYHA, New York Heart Association; LBBB, left bundle branch block; LVEF, left ventricular ejection fraction; LVEDV, left ventricular end-diastolic volume; LVESV, left ventricle end-systolic volume; ACE-I, angiotensin converting enzyme inhibitor; ARB, angiotensin II receptor blocker; CRT-P, cardiac resynchronization pacemaker; CRT-D, cardiac resynchronization defibrillator; LBBB, left bundle branch block; RBBB, right bundle branch block.

^aCardiac sarcoidosis was diagnosed if a non-caseating granuloma was demonstrated by myocardial biopsy (histologic diagnosis), or if non-invasive evidence of cardiac involvement was found in a patient with pathologically proven extracardiac sarcoidosis (clinical diagnosis).

Table 1

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Clinical characteristics of the patients at the CRT implantation

Patient no.	Age (year)	Female	NYHA	Histologic diagnosis^a	Upgrade or de novo	QRS morphology	QRS width (ms)	LVEF (%)	LVEDV (mL)	LVESV (mL)	Beta-blocker	ACE-I or ARB	Corticosteroid	Amiodarone
1	66	Yes	Class III	No	Upgrade from a PM to CRT-P	Paced LBBB	200	18	270	220	Yes	Yes	Yes	No
2	67	Yes	Class III	No	Upgrade from a PM to CRT-P	Paced LBBB	200	10	244	218	No	No	No	No
3	61	Yes	Class IV	No	Upgrade from a PM to CRT-D	Paced LBBB	212	23	282	216	Yes	Yes	No	Yes
4	69	Yes	Class III	No	Upgrade from a PM to CRT-P	Paced LBBB	180	30	208	144	No	Yes	Yes	Yes
5	67	Yes	Class III	No	Upgrade from a PM to CRT-D	Paced LBBB	200	25	253	190	Yes	Yes	No	Yes
6	71	Yes	Class III	Yes	Upgrade from a PM to CRT-P	Paced LBBB	206	31	331	227	Yes	Yes	Yes	No
7	74	Yes	Class III	No	De novo CRT-P	Intrinsic LBBB	194	28	210	151	No	Yes	No	Yes
8	63	Yes	Class II	No	Upgrade from a PM to CRT-P	Paced LBBB	138	33	144	96	Yes	Yes	No	Yes
9	54	Yes	Class III	No	Upgrade from an ICD to CRT-D	Paced LBBB	160	23	292	224	No	No	No	Yes
10	72	Yes	Class III	No	Upgrade from a PM to CRT-P	Paced LBBB	262	21	255	201	Yes	Yes	No	No
11	64	No	Class IV	No	De novo CRT-D	Intrinsic LBBB	132	11	180	160	Yes	Yes	No	Yes
12	64	Yes	Class III	No	Upgrade from a PM to CRT-D	Paced LBBB	200	35	167	108	Yes	Yes	Yes	Yes
13	56	Yes	Class III	No	Upgrade from a PM to CRT-D	Intrinsic RBBB	152	34	233	154	Yes	Yes	Yes	No
14	76	Yes	Class III	Yes	Upgrade from a PM to CRT-P	Paced LBBB	248	29	335	239	Yes	Yes	Yes	Yes
15	68	Yes	Class III	No	De novo CRT-D	Intrinsic LBBB	140	30	154	108	Yes	Yes	No	Yes
16	35	No	Class II	Yes	Upgrade from a PM to CRT-D	Paced LBBB	190	19	231	187	Yes	Yes	Yes	Yes
17	70	Yes	Class III	No	De novo CRT-D	Intrinsic RBBB	164	20	135	108	Yes	Yes	Yes	Yes
18	75	No	Class III	No	De novo CRT-D	Intrinsic LBBB	147	23	216	167	Yes	Yes	Yes	Yes
Mean ± SD or %	65 ± 10	83.3	N/A	16.7	N/A	N/A	185 ± 37	24 ± 6	230 ± 60	173 ± 47	77.8	88.9	50	72.2

Patient no.	Age (year)	Female	NYHA	Histologic diagnosis^a	Upgrade or de novo	QRS morphology	QRS width (ms)	LVEF (%)	LVEDV (mL)	LVESV (mL)	Beta-blocker	ACE-I or ARB	Corticosteroid	Amiodarone
1	66	Yes	Class III	No	Upgrade from a PM to CRT-P	Paced LBBB	200	18	270	220	Yes	Yes	Yes	No
2	67	Yes	Class III	No	Upgrade from a PM to CRT-P	Paced LBBB	200	10	244	218	No	No	No	No
3	61	Yes	Class IV	No	Upgrade from a PM to CRT-D	Paced LBBB	212	23	282	216	Yes	Yes	No	Yes
4	69	Yes	Class III	No	Upgrade from a PM to CRT-P	Paced LBBB	180	30	208	144	No	Yes	Yes	Yes
5	67	Yes	Class III	No	Upgrade from a PM to CRT-D	Paced LBBB	200	25	253	190	Yes	Yes	No	Yes
6	71	Yes	Class III	Yes	Upgrade from a PM to CRT-P	Paced LBBB	206	31	331	227	Yes	Yes	Yes	No
7	74	Yes	Class III	No	De novo CRT-P	Intrinsic LBBB	194	28	210	151	No	Yes	No	Yes
8	63	Yes	Class II	No	Upgrade from a PM to CRT-P	Paced LBBB	138	33	144	96	Yes	Yes	No	Yes
9	54	Yes	Class III	No	Upgrade from an ICD to CRT-D	Paced LBBB	160	23	292	224	No	No	No	Yes
10	72	Yes	Class III	No	Upgrade from a PM to CRT-P	Paced LBBB	262	21	255	201	Yes	Yes	No	No
11	64	No	Class IV	No	De novo CRT-D	Intrinsic LBBB	132	11	180	160	Yes	Yes	No	Yes
12	64	Yes	Class III	No	Upgrade from a PM to CRT-D	Paced LBBB	200	35	167	108	Yes	Yes	Yes	Yes
13	56	Yes	Class III	No	Upgrade from a PM to CRT-D	Intrinsic RBBB	152	34	233	154	Yes	Yes	Yes	No
14	76	Yes	Class III	Yes	Upgrade from a PM to CRT-P	Paced LBBB	248	29	335	239	Yes	Yes	Yes	Yes
15	68	Yes	Class III	No	De novo CRT-D	Intrinsic LBBB	140	30	154	108	Yes	Yes	No	Yes
16	35	No	Class II	Yes	Upgrade from a PM to CRT-D	Paced LBBB	190	19	231	187	Yes	Yes	Yes	Yes
17	70	Yes	Class III	No	De novo CRT-D	Intrinsic RBBB	164	20	135	108	Yes	Yes	Yes	Yes
18	75	No	Class III	No	De novo CRT-D	Intrinsic LBBB	147	23	216	167	Yes	Yes	Yes	Yes
Mean ± SD or %	65 ± 10	83.3	N/A	16.7	N/A	N/A	185 ± 37	24 ± 6	230 ± 60	173 ± 47	77.8	88.9	50	72.2

$Representative images prior to the CRT in patient No. 18. An electrocardiogram showing sinus rhythm with LBBB and a QRS interval of 147 ms (A), echocardiogram exhibiting a severely decreased LV contraction with an ejection fraction of 26% (B), magnetic resonance imaging with a late gadolinium enhancement in the anterior and inferior LV regions (C), and F-18-fluorodeoxyglucos positron emission tomography image that shows diffuse inhomogeneous uptakes in the LV wall (D).$

Figure 1

Representative images prior to the CRT in patient No. 18. An electrocardiogram showing sinus rhythm with LBBB and a QRS interval of 147 ms (A), echocardiogram exhibiting a severely decreased LV contraction with an ejection fraction of 26% (B), magnetic resonance imaging with a late gadolinium enhancement in the anterior and inferior LV regions (C), and F-18-fluorodeoxyglucos positron emission tomography image that shows diffuse inhomogeneous uptakes in the LV wall (D).

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