Risk Stratification in Cardiac Sarcoidosis With Cardiac Positron Emission Tomography: A Systematic Review and Meta-Analysis.

BACKGROUND: Although positron emission tomography (PET) imaging is well established for its diagnostic role in cardiac sarcoidosis, less is known about the prognostic value of PET and its use in risk stratification for major adverse cardiac events (MACE). OBJECTIVES: The goal of this study was to perform a systematic review and meta-analysis looking at the prognostic value of PET imaging in patients with cardiac sarcoidosis. METHODS: Study investigators systematically searched EMBASE (Excerpta Medica dataBASE), MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ClinicalTrials.gov, and the European Union Clinical Trial Registry for cardiac sarcoidosis and PET imaging. The primary outcome of interest was MACE. RESULTS: The search revealed 3,010 records, of which 55 studies were included. This represented 5,250 patients. Factors associated with MACE included the following: the combination of abnormal fluorodeoxyglucose (FDG) uptake and perfusion defect, which had an OR of 2.86 (95% CI: 1.74-4.71; P < 0.0001); abnormal perfusion or FDG uptake, which had an OR of 2.69 (95% CI: 1.67-4.33); abnormal FDG uptake, which had an OR of 2.61 (95% CI: 1.51-4.50); focal abnormal right ventricular uptake, which had an OR of 6.27 (95% CI: 3.19-12.32; P < 0.00001); and a lack of response to immunosuppression on serial PET, which had an OR of 8.43 (95% CI: 3.25-21.85; P < 0.0001). A QUIPS (Quality in Prognostic Studies) tool analysis found a low to moderate risk of bias, particularly given the small sample sizes in the individual studies. CONCLUSIONS: Multiple cardiac PET parameters provide risk stratification value in cardiac sarcoidosis. Focal right ventricular uptake and a lack of response to immunosuppressive therapy on serial PET imaging were particularly predictive of MACE.

Aggressive Cholesterol Pericarditis With Minimal Effusion Masquerading as Treatment-Refractory Autoimmune Disease.

A middle-aged woman with rheumatoid arthritis presented with treatment-refractory pericarditis. Symptoms persisted despite escalation of immunosuppression, and she had recurrent admissions for heart failure. Imaging revealed minimal pericardial effusion and a thickened pericardium. Invasive hemodynamics confirmed constrictive physiology, and a pericardiectomy was required. Pathology testing confirmed cholesterol pericarditis, a rare condition of inflammatory cholesterol deposits within the pericardium. Previous reports describe moderate-to-large volumes of gold-coloured pericardial fluid. This case illustrates that cholesterol pericarditis can present with minimal pericardial effusion and rapidly progress to pericardial constriction.

Une femme d'âge moyen atteinte d'arthrite rhumatoïde a présenté une péricardite réfractaire. Les symptômes ont persisté en dépit de l'escalade de l'immunodépression. Elle a été admise de façon répétitive en raison d'insuffisance cardiaque. L'imagerie a révélé un épanchement péricardique minimal et un péricarde épaissi. L'exploration hémodynamique invasive a permis de confirmer la physiologie constrictive. Une péricardectomie a été nécessaire. L'examen pathologique a permis de confirmer la péricardite cholestérolique, une affection inflammatoire rare due aux dépôts de cholestérol dans le péricarde. Les observations précédentes décrivent des volumes modérés à élevés de liquide péricardique doré. Ce cas illustre que la péricardite cholestérolique peut se traduire par un épanchement péricardique minimal et progresser rapidement vers la péricardite constrictive.

Ictal syncope or isolated syncope? A case report highlighting the overlap.

BACKGROUND: Ictal bradyarrhythmia is a rare condition defined by temporal lobe epilepsy resulting in bradycardia or asystole and can result in syncope. This needs to be differentiated from isolated syncope in patients with seizure disorder, as treatment strategies differ. CASE SUMMARY: A 50-year-old female with well-controlled temporal epilepsy and a 20-year seizure-free period presented to her neurologist with abrupt onset of sudden drop attacks thought to be ictal events with potential underlying ictal bradyarrhythmia and was initially treated with escalation of anticonvulsant therapy. However, her workup was consistent with a diagnosis of cardiac syncope. She subsequently underwent successful insertion of a pacemaker, with no recurrence of her presenting episodes at a 13-month follow-up. DISCUSSION: Ictal syncope and isolated syncope may share a common terminal pathway and may have similar presenting symptoms. In patients with known seizure disorder, loss of consciousness may be attributable to epileptic events, ictal syncope, or isolated syncope-which can be difficult to differentiate. This case highlights the ambiguous nature of such episodes and the importance of simultaneous electroencephalogram/electrocardiogram monitoring, as this can have implications on treatment.

Safety of Lead Repair Compared to Lead Revision for Visible Lead Insulation Defects in Patients With Cardiac Implantable Electronic Devices.

BACKGROUND: Cardiac implantable electronic devices deliver life-sustaining therapy and may be prone to hardware degeneration over time. Functioning transvenous endocardial leads with visible insulation breaks are amenable to lead revision (LRV) or lead repair (LRP), with medical adhesive. The latter is a less invasive and more cost-effective strategy. However, data are sparse on the overall safety of such an approach. METHODS: This is a retrospective cohort study of patients with lead insulation defects managed by either LRV or LRP with medical adhesive. The data analyzed were from January 2010 to January 2021. All-cause mortality, and both early and late complications, was ascertained for all cases. RESULTS: A total of 57 cases were identified, with a mean age (standard deviation) of 75 (±11.8) years; 18 (31.6%) were women. A total of 35 patients (62.5%) underwent LRV for an insulation defect, and 21 (37.5%) underwent LRP. There was no statistical difference in the rate of early and late complications between the 2 groups over a mean follow-up period of 1.15 (±0.78) years [3 (8%)] LRV vs 1 (5%) LRP, P = 0.88). One death was identified in each group, unrelated to either the device or a device-related procedure. There was no association between device type and the likelihood of LRP vs LRV as an attempted strategy (χ2 = 2.25, P = 0.53). CONCLUSIONS: The results of this study suggest that the use of a lead-repair strategy, with silicone adhesive glue and an anchoring sleeve, is not associated with an increased rate of early or late complications, compared with lead revision in the management of visible lead insulation defects with stable lead function.

INTRODUCTION: Les dispositifs cardiaques électroniques implantables offrent un traitement essentiel au maintien de la vie, mais peuvent subir une détérioration de leur matériel au fil du temps. Le fonctionnement des sondes endocavitaires transveineuses ayant des ruptures visibles de l'isolant se prête à la révision de sonde (RVS) ou à la réparation de sonde (RPS) au moyen d'un adhésif médical. Cette dernière stratégie est moins invasive et plus efficiente. Toutefois, les données sur l'innocuité générale d'une telle approche sont rares. MÉTHODES: Il s'agit d'une étude de cohorte rétrospective de patients dont les sondes montrent des défaillances de l'isolant prises en charge par RVS ou par RPS au moyen d'un adhésif médical. Les données analysées s'échelonnaient de janvier 2010 à janvier 2021. La mortalité toutes causes confondues ainsi que les complications précoces et tardives étaient établies pour tous les cas. RÉSULTATS: Nous avons trouvé un total de 57 cas, dont l'âge moyen (écart type) était de 75 (± 11,8) ans; 18 (31,6 %) étaient des femmes. Au total, 35 patients (62,5 %) avaient subi une RVS en raison d'une défaillance de l'isolant, et 21 (37,5 %) avaient subi une RPS. Il n'y avait aucune différence statistique dans le taux de complications précoces et tardives entre les deux groupes durant une période moyenne de suivi 1,15 (± 0,78) an [3 (8 %)] RVS vs un (5 %) RPS, P = 0,88. Dans chaque groupe, nous avons noté 1 décès non associé au dispositif ou à une intervention liée au dispositif. Il n'y avait aucune association entre le type de dispositif et la probabilité de tentative d'une stratégie de RPS vs d'une stratégie de RVS (χ2 = 2,25, P = 0,53). CONCLUSIONS: Les résultats de cette étude montrent que l'utilisation d'une stratégie de RPS au moyen d'un adhésif de silicone et d'une douille d'ancrage n'est pas associée à un taux plus élevé de complications précoces ou tardives que la RVS dans la prise en charge des défaillances visibles de l'isolant de la sonde lors de fonctionnement stable de la sonde.