Hidden under the Surface: A Rare Cause of Repeated Syncope in a Patient with Recent Pacemaker Implantation
A 66-year-old woman received a pacemaker implantation because of syncope with documented sinus arrest and junctional bradycardia. Three weeks later the pacemaker analysis revealed episodes of nonsustained ventricular tachycardia. Coronary angiography and invasive coronary assessment showed diffuse m...
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MDPI AG
2021-06-01
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| Series: | Hearts |
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| Online Access: | https://www.mdpi.com/2673-3846/2/2/23 |
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| author | Leticia Barrios Dagmara Dilling-Boer Axel Jacobs Olivier Ghekiere Philippe Timmermans |
| author_facet | Leticia Barrios Dagmara Dilling-Boer Axel Jacobs Olivier Ghekiere Philippe Timmermans |
| author_sort | Leticia Barrios |
| collection | DOAJ |
| description | A 66-year-old woman received a pacemaker implantation because of syncope with documented sinus arrest and junctional bradycardia. Three weeks later the pacemaker analysis revealed episodes of nonsustained ventricular tachycardia. Coronary angiography and invasive coronary assessment showed diffuse moderate stenosis but no significant ischemia. Three months later she experienced a new syncope and the pacemaker analysis showed runs of nonsustained ventricular tachycardia at the time of syncope. The combination of brady- and tachyarrhythmias raised concern for cardiac sarcoidosis. <sup>18</sup>F-fluorodeoxyglucose positron emission tomography (PET) scan showed increased FDG uptake in the basal segments compatible with inflammatory disease. Cardiac magnetic resonance imaging showed late gadolinium enhancement in the same region of the PET-avid lesions. Diagnostic electrophysiologic study could induce VT. The diagnosis of cardiac sarcoidosis was made, for which high dose corticosteroids were prescribed and an upgrade to a dual chamber implantable cardioverter defibrillator was performed. Because of the localization of the lesions, an endomyocardial biopsy was not performed. All the lesions regressed completely on PET-scan after treatment with high dose corticosteroids. |
| first_indexed | 2024-03-10T10:22:39Z |
| format | Article |
| id | doaj.art-9a138cbc7730496a80c5ce675e2e120f |
| institution | Directory Open Access Journal |
| issn | 2673-3846 |
| language | English |
| last_indexed | 2024-03-10T10:22:39Z |
| publishDate | 2021-06-01 |
| publisher | MDPI AG |
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| spelling | doaj.art-9a138cbc7730496a80c5ce675e2e120f2023-11-22T00:18:47ZengMDPI AGHearts2673-38462021-06-012228829310.3390/hearts2020023Hidden under the Surface: A Rare Cause of Repeated Syncope in a Patient with Recent Pacemaker ImplantationLeticia Barrios0Dagmara Dilling-Boer1Axel Jacobs2Olivier Ghekiere3Philippe Timmermans4Department of Cardiology, Hartcentrum, Jessa Hospital, 3500 Hasselt, BelgiumDepartment of Cardiology, Hartcentrum, Jessa Hospital, 3500 Hasselt, BelgiumDepartment of Nuclear Medicine, Jessa Hospital, 3500 Hasselt, BelgiumDepartment of Radiology, Jessa Hospital, 3500 Hasselt, BelgiumDepartment of Cardiology, Hartcentrum, Jessa Hospital, 3500 Hasselt, BelgiumA 66-year-old woman received a pacemaker implantation because of syncope with documented sinus arrest and junctional bradycardia. Three weeks later the pacemaker analysis revealed episodes of nonsustained ventricular tachycardia. Coronary angiography and invasive coronary assessment showed diffuse moderate stenosis but no significant ischemia. Three months later she experienced a new syncope and the pacemaker analysis showed runs of nonsustained ventricular tachycardia at the time of syncope. The combination of brady- and tachyarrhythmias raised concern for cardiac sarcoidosis. <sup>18</sup>F-fluorodeoxyglucose positron emission tomography (PET) scan showed increased FDG uptake in the basal segments compatible with inflammatory disease. Cardiac magnetic resonance imaging showed late gadolinium enhancement in the same region of the PET-avid lesions. Diagnostic electrophysiologic study could induce VT. The diagnosis of cardiac sarcoidosis was made, for which high dose corticosteroids were prescribed and an upgrade to a dual chamber implantable cardioverter defibrillator was performed. Because of the localization of the lesions, an endomyocardial biopsy was not performed. All the lesions regressed completely on PET-scan after treatment with high dose corticosteroids.https://www.mdpi.com/2673-3846/2/2/23sarcoidosiscardiac magnetic resonancecardiomyopathy |
| spellingShingle | Leticia Barrios Dagmara Dilling-Boer Axel Jacobs Olivier Ghekiere Philippe Timmermans Hidden under the Surface: A Rare Cause of Repeated Syncope in a Patient with Recent Pacemaker Implantation Hearts sarcoidosis cardiac magnetic resonance cardiomyopathy |
| title | Hidden under the Surface: A Rare Cause of Repeated Syncope in a Patient with Recent Pacemaker Implantation |
| title_full | Hidden under the Surface: A Rare Cause of Repeated Syncope in a Patient with Recent Pacemaker Implantation |
| title_fullStr | Hidden under the Surface: A Rare Cause of Repeated Syncope in a Patient with Recent Pacemaker Implantation |
| title_full_unstemmed | Hidden under the Surface: A Rare Cause of Repeated Syncope in a Patient with Recent Pacemaker Implantation |
| title_short | Hidden under the Surface: A Rare Cause of Repeated Syncope in a Patient with Recent Pacemaker Implantation |
| title_sort | hidden under the surface a rare cause of repeated syncope in a patient with recent pacemaker implantation |
| topic | sarcoidosis cardiac magnetic resonance cardiomyopathy |
| url | https://www.mdpi.com/2673-3846/2/2/23 |
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