An investigational modular cardiac rhythm management system successfully prevented new arrhythmias during follow-up in a 52-year-old woman with cardiac sarcoidosis and limited vascular access.
Case Report (n=1)
An investigational modular cardiac rhythm management system combining a leadless pacemaker and S-ICD offers a feasible, leadless alternative for patients with cardiac sarcoidosis who require pacing and defibrillation but have limited vascular access or are immunocompromised.
Abstract Background Cardiac sarcoidosis (CS) is a granulomatous inflammatory disorder that can result in high-grade conduction disease and ventricular arrhythmias, often necessitating permanent pacing and defibrillator support. The transvenous system is particularly challenging in CS with immunosuppression, limited vascular access and a history of chemotherapy. Traditional transvenous systems may be poorly suited for this immunocompromised population. Case summary A 52-year-old woman with a history of breast cancer treated with neoadjuvant chemotherapy and biopsy-confirmed systemic sarcoidosis who presented with shortness of breath and was found to have cardiac involvement based on cardiac magnetic resonance imaging (MRI) and cardiac positron emission tomography (PET) findings, leading to immunosuppressive therapy. She developed non-sustained ventricular tachycardia, followed by high-grade and complete heart block, qualifying her for pacing and defibrillator therapy based on current consensus recommendations. Due to limited vascular access (left-sided mastectomy and right-sided port for chemotherapy), cardiac inflammation and ongoing immunosuppression, an investigational modular cardiac rhythm management (mCRM) system was used, comprising a leadless pacemaker and a subcutaneous implantable cardioverter defibrillator (S-ICD). The patient remained free of new arrhythmias during follow-up and after starting systemic chemotherapy for sigmoid adenocarcinoma. Conclusion The mCRM system manages both bradyarrhythmia and ventricular tachyarrhythmia without the need for intravascular leads. The S-ICD continuously monitors for ventricular arrhythmias and wirelessly commands the leadless pacemaker to deliver anti-tachycardia pacing (ATP) when indicated, potentially avoiding shocks. By eliminating transvenous components, the mCRM system offers a reasonable approach in CS with immunosuppression and limited vascular access.
Sughra et al. (Wed,) conducted a case report in Cardiac sarcoidosis (n=1). Investigational modular cardiac rhythm management (mCRM) system was evaluated on Freedom from new arrhythmias. An investigational modular cardiac rhythm management system successfully prevented new arrhythmias during follow-up in a 52-year-old woman with cardiac sarcoidosis and limited vascular access.