Symptomatic High Degree Heart Block, Complicating Systemic Sarcoidosis

Malka Yahalom1, Ofir Koren1,2, Yoav Turgeman1,3
1 Heart Institute, Ha'Emek Medical Center,, Israel
2 Internal Medicine C, Ha'Emek Medical Center, Israel
3 Rappaport Faculty of Medicine, Technion, Israel

Background: Myocardial involvement in sarcoidosis may be benign, or in some instances may be life-threatening. We report 2 cases of high degree AV Block associated with systemic sarcoidosis.

Purpose: To raise awareness of cardiac involvement in sarcoidosis and its clinical implications.

Patients and Materials: Patient 1 A 43-year-old male presented Stokes-Adams syndrome, related to transient complete heart block which required cardio-pulmonary resuscitation. He was treated by a temporary pacemaker, and shortly after, a permanent pacemaker was implanted. On a chest X-ray, CT and Gallium-scan there was evidence of hilar and axillar lymphadenopathy. The diagnosis of sarcoidosis was confirmed by mediastinal lymph node biopsy.

Patient 2 A 58-year-old female, followed for hyperlipidemia and pulmonic sarcoidosis, presented two years earlier by cough and dyspnea. At that time chest CTscan demonstrated enlarged mediastinal lymph-nodes. Lymph node biopsy showed non- caseating granulomas. Recently the patient presented with fatigue, dizziness and almost syncope, secondary to a high degree AV block ,with no evidence of cardiac ischemia. A permanent pacemaker was implantated. Prior to the implantation there was no evidence of inducible tachyarrhythmia ,on an EPS study.

Conclusions: We present two patients with cardiac sarcoidosis presented with high degree AV Block, who needed pacemaker therapy. One was known as suffering from pulmonary sarcoidosis, and in the second case , the diagnosis was established during the recent event. Our case reports aim to increase awareness of cardiac sarcoidosis ,as a possible cause of syncope and sometimes cardiac arrest. It is recommended that pts with sarcoidosis should undergo early screening for cardiac involvement , by different modalities, and thus save lives.