Surgical Cardiac Sympathetic Denervation in Active Inflammatory Cardiac Sarcoidosis: Rethinking Conventional Timing Paradigms.

BACKGROUND

Sarcoidosis is a systemic inflammatory disorder characterized by noncaseating granulomas, with clinically overt cardiac involvement occurring in 5% to 10% of cases. Cardiac sarcoidosis (CS) may present with malignant ventricular arrhythmias and electrical storm.

CASE SUMMARY: A previously healthy 35-year-old man presented with palpitations and was diagnosed with CS following multimodality imaging and histopathology. He developed recurrent ventricular tachycardia consistent with electrical storm despite medical therapy. An implantable cardioverter-defibrillator was inserted for secondary prevention. Ongoing arrhythmic instability prompted bilateral video-assisted thoracoscopic sympathectomy, resulting in complete cessation of ventricular arrhythmias.

DISCUSSION: CS exhibits heterogeneous clinical manifestations, commonly including conduction abnormalities and ventricular arrhythmias. Diagnosis often requires integration of advanced multimodal cardiac imaging. Immunosuppression is central to controlling active myocardial inflammation, while autonomic modulation may be effective in refractory cases.

TAKE-HOME MESSAGES: CS can masquerade as refractory electrical storm. Multidisciplinary management is essential, and cardiac sympathetic denervation may be a valuable therapeutic option when conventional therapies fail.