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Cardiac sarcoidosis (CS) has been identified as the underlying aetiology in 16–35% of patients presenting with complete atrioventricular (AV) block (age < 60 years) or ventricular tachycardia (VT) of unknown aetiology. There is a growing realization that cardiac sarcoidosis could be the first manifestation of sarcoidosis in any organ. The principal manifestations are conduction abnormalities, ventricular arrhythmias, and heart failure. Clinical picture of manifest cardiac sarcoidosis depends on the location, extent, and activity of the disease.

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The predominant sites of myocardial involvement, in decreasing order of frequency, are the left ventricular free wall and papillary muscles, the basal aspect of the ventricular septum, the right ventricular free wall, and the atrial walls. About 40–50% of patients who die of sarcoidosis-related complications are found to have cardiac sarcoidosis at necropsy despite never having manifested any clinical evidence of myocardial involvement during their lifetime. An estimated 20–25% of patients with pulmonary/systemic sarcoidosis have asymptomatic cardiac involvement (clinically silent disease). Myocardial involvement occurs in at least 25% of patients with sarcoidosis and accounts for as many as 13–25% of deaths from sarcoidosis. The disease can also affect the skin, gastrointestinal tract, eyes, liver, heart, parotid gland, and spleen. More than 90% of patients have involvement of the lungs. It is believed to result from an immunological response to an unidentified antigenic trigger in individuals with genetic susceptibility. Sarcoidosis is a multisystem, granulomatous disease seen worldwide, with a reported prevalence of 4.7–64 in 100,000. Atrial depolarization abnormalities were commoner in patients with pulmonary sarcoidosis. Our study demonstrates a greater prevalence of subtle ECG abnormalities in patients with pulmonary sarcoidosis as compared to patients with other forms of pulmonary disease. There was a higher prevalence of biphasic P wave and bifid P wave in lead III and rsr’ in lead aVF in the study group as compared to the control group. Varying degrees of intraventricular conduction defects were common in the study group, as well as the control group. The findings were compared with those of an age-matched control group.

ResultsĪ detailed analysis of 12-lead ECGs obtained from sixty patients with histopathologically proven pulmonary sarcoidosis and no overt cardiac involvement was done. The objective of this study was to identify the electrocardiographic abnormalities in patients with pulmonary sarcoidosis. Since 12-lead electrocardiogram (ECG) is recommended as an initial screening tool for cardiac sarcoidosis, the recognition of subtle abnormalities assumes utmost significance. Cardiac sarcoidosis, often manifested as sudden death, can be the first manifestation of sarcoidosis.