skip to main content

Cardiac Sarcoidosis - ICD Decision — EECC MCQ

Instant feedback + full explanation. One question, done properly.

HardCardiomyopathyCardiac Sarcoidosis - ICD DecisionEECC

A 55-year-old woman with cardiac sarcoidosis confirmed by endomyocardial biopsy (non-caseating granulomas) has an LVEF of 38% and episodes of NSVT. She is started on prednisolone 40 mg daily. What additional treatment is essential for SCD prevention?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — ICD implantation for primary prevention given the high arrhythmic risk in cardiac sarcoidosis, even with LVEF >35%

Cardiac sarcoidosis carries a disproportionately high risk of malignant arrhythmias and SCD compared with other cardiomyopathies at the same LVEF. The 2022 ESC VA/SCD Guidelines and 2023 ESC Cardiomyopathy Guidelines recommend ICD implantation for cardiac sarcoidosis patients with: (1) LVEF <35% (Class I), (2) LVEF 35-49% with additional risk factors including NSVT, extensive LGE, or inducible sustained VT on EP study (Class IIa). The standard LVEF <35% threshold used for other cardiomyopathies is insufficient for sarcoidosis. Immunosuppression (corticosteroids ± steroid-sparing agents) treats the inflammatory granulomatous process but does not eliminate arrhythmic risk from established scar.

Reference: ESC (2022): Guidelines on VA and SCD Prevention; ESC (2023): Guidelines on Cardiomyopathies