Outcome of implantable cardioverter defibrillator in cardiac sarcoidosis: a systematic review and meta-analysis

Purpose: Cardiac sarcoidosis is a multisystem inflammatory disorder characterized by ventricular arrhythmias. Implantable cardioverter defibrillator (ICD) is used to prevent sudden cardiac death. Methods: We performed literature search for studies that addressed the outcome and complications of ICD in Cardiac Sarcoidosis (CS). Multiple search sites were reviewed from January 1, 2000 until December 1, 2018. We then performed a meta-analysis using a random effects model. Two investigators independently extracted the data and assessed studies’ quality. Results: Ten studies with 585 patients qualified for the analysis. In the pooled analysis, 57% were male with mean left ventricular ejection fraction (LVEF) of 38.4%. Appropriate and inappropriate ICD treatments (AT and IAT) were reported in 39% and 15% of patients respectively over mean follow-up period of 25 months and mortality rate of 8%. A sub-analysis of four studies indicated that patients with appropriate therapy did not differ from the rest of CS population in LVEF% (mean difference (MD) = − 7.37%, 95% confidence interval (CI) − 16.89 to 2.15, p = 0.12), age (MD = − 3.87 years, 95% CI − 10.19 to 2.46, p = 0.23), primary prevention (range difference (RD) = − 0.11, 95% CI − 0.31 to 0.10, p = 0.31) or secondary prevention indication (RD = 0.09, 95% CI − 0.12 to 0.3, p = 0.37). High degree AV block was more common in patients with AT (RD = 0.07, 95% CI 0.00 to 0.14 p = 0.05). Conclusions: ICD placement in CS is associated with high incidence of both appropriate and inappropriate therapy. High degree AV block appears to be predictive of appropriate ICD therapy.