Premature Ventricular Complexes and Nonsustained Ventricular Tachycardia in Cardiac Sarcoidosis.

Background: The prevalence and prognostic significance of frequent premature ventricular complexes (PVCs) and nonsustained ventricular tachycardia (NSVT) in cardiac sarcoidosis (CS), especially in patients with normal or mildly decreased left ventricular function, have not been studied.

Objectives: This study sought to investigate the prognostic value of PVCs and NSVT in patients with CS and normal or mildly decreased left ventricular ejection fraction.

Methods: We included 192 patients with definite or probable CS with left ventricular ejection fraction >35% and no previous history of ventricular tachycardia (VT)/ventricular fibrillation (VF) or sudden cardiac death, who underwent up to 48 hours of clinically indicated Holter monitoring. Baseline PVC burden and presence of NSVT were correlated with presence of fluorodeoxyglucose (FDG) uptake on positron emission tomography and late gadolinium enhancement (LGE) on magnetic resonance imaging. We performed multivariable analysis for the associations of PVC burden and NSVT with the composite endpoint of sustained VT/VF, advanced heart failure therapy, and all-cause mortality.

Results: The median PVC burden was 0.3% (Q1-Q3: 0.02%-2.5%), and 36 (18.8%) patients had PVC burden ≥5%. Sixty-two patients (32.3%) had NSVT detected during Holter monitoring. PVC burden and NSVT had an association with LGE presence but not with FDG uptake. A total of 33 patients (17.2%) experienced the composite endpoint during a median follow-up of a 3 years. In multivariable analysis, PVC burden ≥5% vs <5% (HR: 2.84; 95% CI: 1.26-6.40; P < 0.01) and presence of NSVT (HR: 4.74; 95% CI: 2.15-10.46; P < 0.01) were associated with the composite endpoint.

Conclusions: Our results suggest that an elevated PVC burden and the presence of NSVT are prognostically relevant and may have a role in the risk stratification of patients with CS.