Introduction: Sarcoidosis is a multisystem disease with cardiac involvement dominating the patients’ prognosis. The role of catheter ablation of ventricular arrhythmias is unclear as especially in the acute inflammatory phase of the disease immunosuppressive drug treatment is recommended rather than antiarrhythmic therapy including catheter ablation. Nonetheless, in the presence of multiple ventricular tachycardias (VT) or even electrical storm and/or failure of antiarrhythmic drug treatment ablation may be important.

Methods: We enrolled 13 patients with biopsy proven cardiac sarcoidosis and implantable cardioverter defibrillator (ICD) who underwent catheter ablation for VT over a period of 8 years (2010-2018) from our single-center ablation registry.

Results: In these 13 patients, a total 19 electroof physiologic studies studies were performed. In 9 of these 19 studies long-term successful endocardial catheter ablation of monomorphic VT was performed. In 7 studies only ventricular fibrillation or polymorphic fast VT were inducible so that no ablation was performed and antiarrhythmic as well as immunosuppressive drug treatment was intensified. In the remaining 3 studies recurrent VT or premature ventricular complexes could not sufficiently been suppressed during follow-up so that antiarrhythmic drug therapy was escalated. There were no complications regarding the ablation procedure except for an AV-Block III° in a patient with septal VT who already had a DDD-ICD-system because of an AV-Block II°. During a mean follow-up of 36 months, only one patient died because of a  pneumogenic sepsis.

Conclusion: Ventricular tachycardias in cardiac sarcoidosis are a common problem of a rare disease. Treatment is difficult due to various and disseminated substrates and further hampered due to acute inflammatory processes. Nonetheless, in sarcoid patients with ICD suffering from recurrent ICD interventions, acute endocardial catheter ablation was successful in 75% of patients with inducible monomorphic VT.