ICD for VT in Cardiac Sarcoidosis — EECC MCQ

Correct answer: E — Yes — cardiac sarcoidosis is classified as an arrhythmogenic condition where ICD should be considered at LVEF thresholds above the standard 35% due to high SCD risk from granulomatous scar; sustained VT is a Class I indication for secondary prevention ICD regardless of LVEF

Cardiac sarcoidosis has disproportionately high arrhythmic risk relative to LVEF because: (1) granulomatous inflammation and resulting scar create re-entrant arrhythmic substrates; (2) active inflammation causes triggered activity; (3) conduction system infiltration causes AV block. The 2022 ESC VA/SCD and 2023 ESC Cardiomyopathy Guidelines recommend: (1) sustained VT = Class I ICD (secondary prevention — regardless of LVEF); (2) primary prevention ICD: should be considered at LVEF ≤35% (Class IIa), and may be considered at LVEF 36-49% with other risk factors (NSVT, extensive LGE, EP study inducibility — Class IIb); (3) immunosuppression may reduce arrhythmic burden from active inflammation but does NOT eliminate the risk from established scar; (4) catheter ablation for recurrent VT despite AAD (epicardial substrate is common in sarcoidosis — requiring combined endocardial/epicardial ablation approach).

Reference: ESC (2022): VA/SCD; ESC (2023): Cardiomyopathies