Author + information
- Tomas G. Neilan, MD∗ ( and )
- Raymond Kwong, MD, MPH
- ↵∗Department of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 5, Boston, Massachusetts 02114
We thank Dr. Aneja for the interest in our article (1) and also appreciate that the feedback that the information provided in the article was of use when you were involved in the care of a patient surviving sudden cardiac arrest.
Sarcoidosis consists of both an active, inflammatory phase as well as a chronic phase, in which scarring and fibrosis are present. Although the cardiac magnetic resonance (CMR) features of the 2 conditions overlap especially during the acute phase, there are some suggestive features that help differentiate the two (2,3). The following features are typically seen in cardiac sarcoidosis (2,3):
1. Late gadolinium enhancement (LGE) in cardiac sarcoidosis often involves more than one segment, in a basal distribution, and often involves the septum.
2. The LGE pattern can have both a subendocardial and a sub-epicardial distribution with areas of completely normal-appearing myocardium in between segments of LGE.
3. The chronic phase usually has basal thinning of the left ventricle.
As pointed out by Dr. Aneja, the guidelines appropriately advise the insertion of an implantable cardioverter defibrillator in a cohort such as that detailed in our study (4), in additional to other therapy that may modify the arrhythmic substrate (5). Indeed, experience from this institution and others have shown that once a patient is confirmed to have a high probability of having cardiac sarcoidosis by imaging, clinicians often choose to utilize implantable cardioverter defibrillator therapy for preemptive prevention of sudden cardiac death from serious arrhythmias (5).
Please note: Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation