Sarcoidosis of the heart presenting with ventricular tachycardia and atrioventricular block

Direct involvement of the myocardium, a serious complication of sarcoidosis, was observed in 2 cases. The first patient had a progressively downhill course over 2 1 2 years, ending in sudden death. Her disease was characterized by recurrent ventricular arrhythmias, progressive heart failure and terminal arrhythmia. Cardiac catheterization and cineangiocardiograms performed before death revealed 2 ventricular aneurysms. Postmortem examination revealed extensive fibrosis and typical noncaseating granulomatous infiltration of the myocardium. The second patient presented with complete heart block. At the time of implantation of an epicardial pacemaker, biopsy of the myocardium and a mediastinal lymph node showed the noncaseating granulomas of sarcoidosis. In the subsequent years, atrioventricular (A-V) conduction improved and, when last seen, the patient maintained a normal sinus rhythm with first degree atrioventricular block.