A patient with atrioventricular block and ventricular tachycardia: think sarcoid!

Cardiac involvement in sarcoidosis is often difficult to diagnose, and most alarmingly can lead to sudden cardiac arrest as its first manifestation. We report the case of a 45-year-old Indian woman with an implanted permanent pacemaker for atrioventricular block, who presented with haemodynamically stable ventricular tachycardia and was found to have impaired left ventricular function. Subsequent investigations established the diagnosis of cardiac sarcoidosis. The patient was treated with prednisolone initially at 40 mg a day for 3 months. Left ventricular function improved over 3 months of treatment and there was no further recurrence of ventricular tachycardia. Screening for cardiac sarcoidosis should be considered in a patient with unexplained atrioventricular block and ventricular tachycardia, particularly if young, even in the absence of clinical findings of extracardiac sarcoidosis. Treatment of the cardiac sarcoidosis could control ventricular tachycardia and improve left ventricular function.