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Sarcoidosis

AICD

11/02/2006

Question:

What would be the reasons for an AICD in a pt with cardiac sarcoidosis? I had a patchy uptake during exercise and at rest on a thallium cardiac stress test. I also had atrial flutter documented on a monitor while trying to wean down to 15mg a day of prednisone (was on 17.5mg per day for several months and much higher doses prior to that for a total of over 2 yrs of steroids). I`ve had no V-fib/tach. Basically, I`m scared to have this AICD done since will be under general anesthesia an have many other heatlth problems. I do trust my doctors but had a prior cardiologist for 2 yrs that said all was ok. Now I find out the same tests he said was ok are not according to my new cardiologists. I am going to go in and talk with my AICD doctor again before scheduling any surgery but I have posted here and read many of your responses to questions and I just wanted to know what you would require as prerequisites to having this type of surgery done. I am overwt (steroids), diabetic (steroids), and have many other health issues. Thank you for this service that you provide.

Answer:

Dear Sir/Madam-
 
Your cardiologists have the advantage of having more information than I do about the severity and extent of your heart disease so I will not attempt to weigh in on the recommendation to place an AICD. 
 
This being said, an AICD is generally indicated for anyone who would be at high risk for a potentially fatal abnormal rhythm of the heart, especially V-fib/tach.  Sarcoidosis rarely is fatal, but abnormal heart rhythms are one the leading causes of death in patients with sarcoidosis involving the heart. 
 
If your disease is difficult to control and there is evidence of significant heart involvement, as reflected by abnormal heart function (poor muscle contraction) and/or irregular heart beats (especially those arising from the lower parts of the heart), placing the AICD may be wise. 
 
Optimization of your sarcoidosis treatment is also a high priority.  If high doses of steroids are required to manage your disease, it is reasonable to consider a "steroid sparing" agent (e.g. methotrexate) to reduce the steroid requirement. Consultation from a regional expert in the management of sarcoidosis patients is recommended. 
 
AICD placement is not considered a "high risk" surgical procedure.  They are placed routinely in patients with advanced heart disease.
 
Sincerely,
 
Elliott Crouser MD
The Ohio State University Medical Center

For more information:

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Response by:

Elliott D Crouser, MD Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University