A Case of Ventricular Tachycardia Due to Cardiac Sarcoidosis Newly Diagnosed by Multimodality Imaging

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A 50 year-old female attended to our hospital complaining of intermittent palpitation and pre-syncope. Her Electrocardiogram revealed wide QRS tachycardia with atrioventricular disconnection, CRBBB pattern and downward direction. Intravenous Lidocaine was effective to return to sinus rhythm. Her chest X-ray showed bilateral hilar lymphadenopathy and her transthoracic echocardiogram showed localized swelling of basal septum of left ventricle and normal left ventricular contraction. Ischemic heart disease was ruled out by 64-row multidetector computed tomography. We suspected cardiac sarcoidosis and performed several imaging studies. Cardiac magnetic resonance imaging showed Gadolinium delayed enhancement in basal septum of left ventricle, the same site of the swelling in echocardiogram. In 67-Ga scintigraphy there were significant uptake in bilateral pulmonary hilum, subclavian lymph nodes and left inguinal lymph node, but it was difficult to identify the uptake of the heart. Fasting 18F-fluoro-deoxyglucose positron emission tomography showed the strong uptake in basal septum of left ventricle and other sites similar with 67-Ga scintigram. We diagnosed her with cardiac sarcoidosis and judged the indication of the implantable cardioverter defibrillator (ICD). We performed ICD implantation and started corticosteroid therapy.