Demonstration of transient entrainment in monomorphic sustained ventricular tachycardia associated with cardiac sarcoidosis

A 49-year-old man was referred fur further treatment of sustained monomorph ic ventricular tachycardia (VT) associated with cardiac sarcoidosis. During an electrophysiologic study (EP), dl-sotalol suppressed the spontaneous VT and prevented induction of VT. However, when predonisolone treatment was s tarted, monomorphic VT recurred frequently. To terminate the VT, a temporal pacing lead was placed at the apex of the right ventricle, and programmed electrical stimulation was attempted from the lead. During the EP study, 2 different monomorphic VTs were repetitively induced and both types were abl e to be terminated by rapid ventricular pacing; in one of the VT morphologi es, constant and progressive fusion was obvious during the ventricular paci ng. Some monomorphic VTs associated with cardiac sarcoidosis are due to ree ntry with an excitable gap, but the clinical efficacy of EP-guided antiarrh ythmic drug treatment seems to be less certain during steroid therapy. In t he present case, a defibrillator device was implanted to prevent a possible arrhythmic event.