P325 CARDIAC SARCOIDOSIS PRESENTING WITH ATRIOVENTRICULAR BLOCK AND SUBSEQUENT CARDIAC ARREST: A CASE REPORT

Abstract A 53–year–old male patient with no significant past medical history and familiar for cardiac diseases presented to the emergency department asymptomatic bradycardia. The ECG showed complete atrioventricular block in absence of pathological findings on echocardiogram coronary lesions were found angiography. underwent pacemaker (PM) implantation. few months later suffered from arrest sustained ventricular tachycardia, effectively treated DC shock. mild right dilation dysfunction regional wall motion abnormalities, especially subtricuspid site. Cardiac magnetic resonance imaging (MRI) focal areas delayed enhancement a non–ischaemic pattern distribution hook sign, highly suggestive sarcoidosis. FDG PET cardiac, hepatic, splenic, lymph nodal uptake. In suspicion systemic sarcoidosis, an hepatic biopsy was performed, being liver most accessible histological examination presence non–caseating granulomas. Therefore, diagnosis Systemic Sarcoidosis (SS) involvement made PM upgraded CRT–D secondary prevention. discharged cortisone therapy. Three after discharge, new total body PET–CT scan performed showed, comparison previous one, hypermetabolism bone fields. sarcoidosis (CS) is rare inflammatory granulomatous myocardial disease unknown etiology that should be suspected young patients conduction disturbances complex arrhythmias. diagnostic approach challenging: techniques (MRI, PET) can CS but demonstration non–caseous granuloma mandatory. Endomyocardial (which has suboptimal sensitivity due lesion) could avoided if there more less invasive extracardiac site biopsy. Early relies multidisciplinary collaboration essential staging long–term management prevention sudden death. Cortisone therapy remains mainstay treatment.