Abstract
BackgroundCardiac sarcoidosis (CS) causes severe conduction abnormalities and arrhythmias. CS patients are increasingly being treated with cardiac resynchronization therapy-defibrillators (CRT-Ds). For the first time, we report the anesthetic management of a CS patient with a CRT-D.Case presentationA 65-year-old male with an implanted CRT-D due to CS was scheduled for a laparoscopy-assisted total proctocolectomy for his transverse colon cancer. His left ventricular ejection fraction was 32.0%, and his physical status was a New York Heart Association class III. General and epidural anesthesia were performed while using standard monitors and a FloTracTM system. The dual-chamber pacing (DDD) modality of the CRT-D was unchanged, and its defibrillation function was deactivated before surgery. The surgery was successfully performed, and the patient was discharged without worsening of his cardiac condition.ConclusionsA detailed understanding of this patient’s condition, as well as sarcoidosis, helped to facilitate successful anesthetic management of this patient.
Highlights
Cardiac sarcoidosis (CS) causes severe conduction abnormalities and arrhythmias
* Correspondence: ai-fuji823@hotmail.co.jp 2Operating Rooms, Kyushu University Hospital, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan Full list of author information is available at the end of the article recommended for the treatment of arrhythmias [5], implantation of a cardiac resynchronization therapydefibrillator (CRT-D) is appropriate for patients with a high risk of severe arrhythmias or heart failure [6, 7]
Cardiac involvement is reported clinically in 5% of sarcoidosis patients; autopsy and cardiovascular magnetic resonance studies have shown a higher percentage of subclinical cardiac involvement, ranging from 15 to 80%, which accounts for the majority of sarcoidosis-related deaths [2, 3, 14]
Summary
Cardiac sarcoidosis (CS) causes severe conduction abnormalities and arrhythmias. CS patients are increasingly being treated with cardiac resynchronization therapy-defibrillators (CRT-Ds). Conclusions: A detailed understanding of this patient’s condition, as well as sarcoidosis, helped to facilitate successful anesthetic management of this patient. The three main manifestations of cardiac sarcoidosis (CS) are conduction abnormalities; ventricular arrhythmias, including sudden cardiac death; and heart failure [2,3,4].
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