An International Survey of Current Clinical Practice in the Treatment of Cardiac Sarcoidosis.

Cardiac sarcoidosis (CS) is a potentially serious form of infiltrative cardiomyopathy. Despite scarce evidence, immunosuppressive treatment is generally recommended, but local routines may vary significantly. We sought to survey the clinical practices in the treatment of CS, with the aim that the results may suggest future research priorities. We conducted a web-based survey focused on treatment-naive patients with CS. We subclassified CS according to the presence/absence of overt cardiac presentation (clinically manifest/silent) and to the presence/absence of active inflammation (metabolically active/inactive by fluorodeoxyglucose positron emission tomography). The survey was developed jointly by the authors and administered to expert clinicians (n = 79) involved in CS treatment. An agreement threshold was set at 70%. A total of 62 of 79 respondents (78.5%) from 12 countries completed the survey. The agreement threshold was reached for: (1) always treating clinically manifest, metabolically active CS, 57 of 62 (91.9%), (2) never treating clinically silent, metabolically inactive CS, 44 of 62 (71.0%), (3) not requiring histopathologic confirmation of sarcoidosis before treatment initiation, (49 of 62, 79.0%), (4) using fluorodeoxyglucose positron emission tomography for assessing treatment indication (44 of 62, 71.0%) and treatment response (44 of 62, 71.0%), and (5) using prednisone as a first-line agent (100%), although respondents were divided on monotherapy (69.4%) or combination with methotrexate 25.8%. The approach to particular scenarios, tapering, and duration of treatment showed the greatest variation in response. In conclusion, in this survey of clinical practice, important aspects of CS treatment reached the agreement threshold, whereas others showed a great degree of clinical equipoise.

Degenerating regenerating torsades de pointes.

Ventricular fibrillation (VF) commonly ends in death. Isolated case reports describe the uncommon occurrence of spontaneous termination of VF. Torsades de pointes (TdP), a peculiar form of polymorphic ventricular tachycardia associated with a prolonged QT interval on the surface electrocardiogram, most often spontaneously terminates and then returns to the underlying rhythm. Here, we present an unusual case of TdP degenerating into VF, reorganizing into TdP, and then spontaneously terminating. Our case suggests that the mechanisms underlying the maintenance of TdP and VF are not dissimilar. The precipitants to this event and the likely mechanisms operative are discussed.