Table 4.

Current recommendations by expert societies for an implantable cardioverter-defibrillator in patients with cardiac sarcoidosis

Classa	2014 HRS Consensus Statement on Management of Arrhythmias in Cardiac Sarcoidosis4	2017 AHA/ACC/HRS Guideline for Management of Ventricular Arrhythmias and Prevention of Sudden Cardiac Death153	2022 ESC Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death154
I	Prior aborted cardiac arrest, documented spontaneous sustained ventricular tachycardia, or LVEF ≤ 35%b,c
IIa	LVEF > 35% with an indication for permanent pacemaker
	History of syncope compatible with arrhythmogenic etiology
	Inducible sustained ventricular arrhythmia at PES		Inducible sustained monomorphic ventricular arrhythmia at PES in a patient with LVEF 35%–50% and minor LGE at CMRI
		LVEF > 35% with evidence of myocardial scar (or ‘extensive scar’) by CMRI or PETc	LVEF >35% with significant myocardial LGE at CMRI after resolution of acute inflammation
IIb	LVEF 36%–49% or RVEF < 40%b

ACC indicates American College of Cardiology; AHA, American Heart Association; CMRI, cardiac magnetic resonance imaging; ESC, European Society of Cardiology; HRS, Heart Rhythm Society; LGE, late gadolinium enhancement; LVEF, left ventricular ejection fraction; PES, programmed electrical stimulation; PET, positron emission tomography; RVEF, right ventricular ejection fraction.

Class I is recommended (‘is useful/indicated/beneficial’, ‘should be performed’); Class IIa, modest recommendation (‘can be useful/beneficial’, ‘should be considered’); and Class IIb, weak recommendation (‘usefulness is unknown/uncertain’, ‘may/might be considered’).

2014 HRS guidance presupposes optimal medical therapy and a period of immunosuppression in the presence of active inflammation.

2017 ACC/AHA/HRS guideline presupposes meaningful expected survival ≥1 year.