Prevention of sudden cardiac death by the wearable cardioverter defibrillator in a young patient with cardiac sarcoidosis

To cite: Andrié R, Gaertner FC, Skowasch D. Thorax 2017;72:286–287. Patients with sarcoidosis with cardiac manifestation have a worse prognosis due to sudden cardiac death. The most important predictor of survival appears to be left ventricular function. A 25-year-old female patient was transferred to our hospital. Initial echocardiography demonstrated a reduced ejection fraction (EF) of 30%. Based on CT scan, a diagnosis of cardiac sarcoidosis was suspected. This was proven by transbronchial biopsy. As a novel method, macrophage-directed positron emission tomography (PET)/CT using the somatostatin receptor ligand Ga-DOTA-TOC was used to image active inflammation in the thorax. Potential advantages of Ga-DOTA-TOC over F-FDG are a lower radiation exposure and a simplified and less artefact-prone imaging procedure as elaborate patient preparation protocols suppressing physiologic myocardial glucose uptake are not needed with Ga-DOTA-TOC. Areas of abnormally increased tracer uptake consistent with inflammatory changes were observed both in the lung (figure 1A) and in the left ventricle (figure 1C). Corticoid treatment and heart failure medication were initiated leading to a rapid clinical improvement, accompanied by an increase in EF (45%) and reduction in inflammation as seen in the follow-up by Ga-DOTA-TOC 4 months later (figure 1B,D). In anticipation of an improvement of EF, the patient was equipped with the wearable cardioverter defibrillator (WCD, LifeVest system, Zoll) to protect against sudden cardiac death. This allowed insertion of an implantable cardioverter defibrillator (ICD) to be deferred. One day after discharge, the patient presented with symptomatic sustained ventricular tachycardia, that was detected and terminated by one shock (figure 1E). Despite