Characterizing Atrial Fibrillation in Cardiac Sarcoidosis

In a report, published in the International Journal of Cardiology, researchers examined the incidence of atrial fibrillation (AF) and other atrial arrhythmias in patients with cardiac sarcoidosis (CS), a “growing interest in the field of infiltrative cardiomyopathies,” according to lead author, Carlson Sama, MD. Dr. Sama and colleagues meta-analyzed studies published to the PubMed, Medline, Web of Science, and Scopus databases to synthesize available data.

Based on trials published by April 26, 2023, the investigators concluded that AF and related arrhythmias represent a “considerable” burden to patients with CS. Specifically, the rate of incident AF appeared to double in the first 2 years of follow-up, then become relatively stable, according to Dr. Sama.

Left Atrial Size Predicts Arrhythmias in CS

Analysts used random-effects models to generate separate plots for each effect size of interest. Across 8 studies with 978 total patients with CS, researchers estimated the pooled prevalence of AF was 23% (95% CI, 13-34). Paroxysmal AF was more common than persistent AF at 83% (95% CI, 77-90) versus 17% (95% CI, 10-23), respectively.

In a separate analysis of 9 studies containing 545 patients with CS, the pooled incidence of AF was 5.0% within 2 years, 13.1% in years 2 through 4, and 8.9% after 4 years of follow-up. Over 6 years of follow-up, the overall cumulative incidence of AF was 10.6% (95% CI, 4.9-17.8). Additionally, the study found increased left atrial size and atrial uptake of ¹⁸F-fluorodeoxyglucose were strong independent predictors of atrial arrhythmia development via qualitative analyses. Patients with CS and AF also exhibited greater risk for adverse outcomes versus those with CS without AF.

Ultimately, Dr. Sama and colleagues concluded their results necessitate “close follow-up and predictive risk-stratification tools to guide the initiation of appropriate strategies, including therapeutic interventions for prevention of AF-related embolic phenomenon, especially in those with known clinical predictors.”

Related: Atrial Fibrillation Ablation Is Effective in Patients With End-stage Heart Failure