Cardiac Sarcoidosis : Treatment
Some patients with sarcoidosis undergo spontaneous remission. Most cardiac sarcoidosis patients receive initial immunosuppressive treatment with corticosteroids. Steroids control inflammation, prevent fibrosis, and preserve cardiac function, although there is no conclusive proof of long-term survival benefit from this regimen. In refractory cases or if there are significant side effects to steroids, methotrexate is used as a second-line agent. Other therapies include azathioprine, cyclophosphamide, and infliximab. Non-pharmacologic approaches include the use of pacemaker, implantable cardioverter-defibrillator devices, and catheter ablation of arrhythmogenic scars. Cardiac transplantation has been successfully performed in younger patients and offers long-term survival; however, there is a risk of recurrence of the disease in the transplanted heart. The long-term prognosis is poor in patients who develop heart failure. Between 15% to 25% of deaths in sarcoidosis are attributed to cardiac involvement. Five year survival rates range between 60%-90%. The image shows a scar-like area of interstitial fibrosis with multinucleated giant cells and lymphocytic infiltrate. Image courtesy of: Megan Quinn, MD; used with permission.