Incidence and Predictors of Sudden Cardiac Arrest in Sarcoidosis A Nationwide Analysis

OBJECTIVES This study sought to identify electrocardiographic (ECG) and clinical predictors of sudden cardiac arrest (SCA) in sarcoidosis. BACKGROUND Sudden cardiac death (SCD) is the leading cause of death in cardiac sarcoidosis (CS) and may be the earliest manifestation of disease. Widespread or repeated advanced imaging is a challenging solution to this problem. ECG is an affordable and widely accessible modality that could help guide diagnostic approaches and risk stratification. METHODS Data were obtained from the National Inpatient Sample (2005-2017) using International Classifi-cation of Diseases-9th Revision and-10th Revision-Clinical Modification. The primary outcome was to identify predictors of SCA, whereas predictors of SCA in young individuals and those with normal ventricular function served as secondary measures. Furthermore, temporal trends in sarcoidosis as well as SCA were also analyzed. Logistic regression analysis was used to calculate odds ratios, following which a multivariable regression was used to adjust for potential confounders. RESULTS Electrocardiographic markers of AV node dysfunction or bundle branch block are associated with substantially increased risk of SCA in a limited proportion of patients (8.6%). This association is also observed among younger patients (<40 years) and those with normal ventricular function. CONCLUSIONS ECG evidence of AV nodal dysfunction or distal conduction disease should raise suspicion for cardiac involvement in patients with sarcoidosis and are associated with increased risk of SCA. ECG markers could help identify patients who would benefit from advanced imaging. The sensitivity of ECGs is, however, limited and presence of a normal ECG does not reflect a low risk of SCA. (J Am Coll Cardiol EP 2021;7:1087-1095) (c) 2021 by the American College of Cardiology Foundation.

Automated summary

This study identified that electrocardiographic markers of AV node dysfunction or bundle branch block are associated with increased risk of sudden cardiac arrest (SCA) in patients with sarcoidosis. This association was observed in younger patients (<40 years) and those with normal ventricular function.