Outcomes of catheter ablation in cardiac sarcoidosis patients with ventricular tachycardia: a propensity score-matched retrospective analysis

Background: Ventricular tachycardia (VT) in patients with cardiac sarcoidosis (CS) can lead to sudden cardiac death. The role of ventricular tachycardia ablation (VTA) in CS has been investigated in a few small, single-center, and larger observational studies, but the evidence still needs to be provided. This study aimed to investigate the clinical outcomes of VTA in patients with CS admitted with a diagnosis of VT.

Methods: A retrospective analysis was conducted using the TriNetX database: US collaborative network from 2010 to 2024. Patients undergoing ablation for VT with and without CS were identified. Two groups were created for propensity score analysis matching a history of hypertension, diabetes, obesity, peripheral vascular diseases, heart failure, ischemic heart diseases, atrial fibrillation, and chronic kidney disease. The primary outcome was the incidence of death, cardiogenic shock, heart failure, acute myocardial infarction, hemorrhagic stroke, ischemic stroke, and ventricular tachycardia within 1 year from the date of the index procedure.

Results: Out of 15,958 patients who underwent catheter ablation for VT, 778 patients had CS. After propensity matching, the mean age of patients with VT and CS who underwent ablation was 58.6 (SD = 11.3), compared to 59.5 (SD = 13) in patients with VT without CS (p-value = 0.07). The propensity-matched analysis showed no significant differences in procedure-related complications between those with cardiac sarcoidosis (CS) and those without. Both cohorts had 10 events each for cardiac tamponade (p = 0.195), groin hematoma requiring transfusion (p = 0.102), pneumothorax (p = 0.317), and sepsis (p = 0.654). Cardiogenic shock occurred in 13 patients in the non-CS group versus 12 in the CS group (p = 0.840). At the 1-year follow-up, there was no significant difference in the mortality rate between the two groups (HR = 1.228, 95% CI 0.834-1.809, p = 0.298). Cardiogenic shock was also similar, with 13 events in the non-CS group and 12 in the CS group (HR = 0.879, 95% CI 0.636-1.213, p = 0.430). However, CS was associated with a higher risk of acute exacerbation of heart failure (314 in non-CS vs. 378 in CS, HR = 0.823, 95% CI 0.709-0.956, p = 0.010) and a lower risk of acute myocardial infarction (96 in non-CS vs. 74 in CS, HR = 1.389, 95% CI 1.026-1.881, p = 0.033). There was no significant difference in ICD shock (147 in non-CS vs. 185 in CS, HR = 0.817, 95% CI 0.658-1.014, p = 0.066), ischemic stroke (10 cases each, HR = 0.941, 95% CI 0.382-2.316, p = 0.895), or hemorrhagic stroke (10 cases each, HR = 1.455, 95% CI 0.326-6.501, p = 0.620). However, CS was associated with a higher risk of pericarditis (91 in non-CS vs. 151 in CS, HR = 0.593, 95% CI 0.457-0.769, p < 0.05). At the 5-year follow-up, CS was associated with a lower risk of mortality (123 deaths in non-CS vs. 104 in CS, HR = 1.341, 95% CI 1.033-1.741, p = 0.027) and a lower risk of acute myocardial infarction (134 in non-CS vs. 109 in CS, HR = 1.381, 95% CI 1.072-1.778, p = 0.012). CS patients had a higher risk of acute exacerbation of heart failure (366 in non-CS vs. 467 in CS, HR = 0.780, 95% CI 0.680-0.894, p < 0.05) and ICD shock (182 in non-CS vs. 242 in CS, HR = 0.789, 95% CI 0.651-0.956, p = 0.015). There were no significant differences in the incidence of cardiogenic shock (98 in non-CS vs. 129 in CS, HR = 0.825, 95% CI 0.635-1.074, p = 0.150), ischemic stroke (11 in non-CS vs. 12 in CS, HR = 0.981, 95% CI 0.433-2.224, p = 0.963), or hemorrhagic stroke (10 cases each, HR = 1.320, 95% CI 0.509-3.424, p = 0.570). The risk of pericarditis was higher in CS patients (122 in non-CS vs. 187 in CS, HR = 0.655, 95% CI 0.522-0.823, p < 0.05).

Conclusion: Cardiac sarcoidosis's influence on immediate periprocedural complications was comparable to that of non-cardiac sarcoidosis in patients undergoing catheter ablation. However, it was associated with increased incidences of pericarditis, acute heart failure exacerbations at 1 and 5 years, and ICD shocks at 5 years of follow-up. These findings support VT ablation as a reasonable and safe therapeutic option for cardiac sarcoidosis patients. Operators should be prepared to address the unique challenges of this population, including potential follow-up complications and their management. Further prospective and multicenter studies are warranted to validate these findings and optimize clinical outcomes.