Table 3.
—Management of Cardiac Sarcoidosis
| Topic | Procedure |
| Indications for initiation of immunomodulatory therapy (R1, Q12) | Hypermetabolic activity on a cardiac FDG-PET scan |
| Delayed enhancement on cardiac MRI | |
| Conduction defects | |
| LV dysfunction | |
| RV dysfunction in the absence of pulmonary hypertension | |
| Ventricular arrhythmias | |
| Atrial arrhythmias | |
| Other | |
| Clinical scenario: asymptomatic patient with only a positive PET scan (R2, Q3) | No |
| Yes | |
| Other | |
| Clinical scenario: asymptomatic patient with only a positive MRI scan (R2, Q4) | No |
| Yes | |
| Other | |
| Immunosuppressive therapies used in treating cardiac sarcoidosis (R1, Q13) | Prednisone |
| Methotrexate | |
| Azathioprine | |
| Mycophenolate mofetil | |
| Anti-TNF agent | |
| Other | |
| Dose of prednisone used (R1, Q14) | 20 mg |
| 30-40 mg | |
| 60 mg | |
| 0.5 mg/kg/ideal body weight | |
| 1 mg/kg/ideal body weight | |
| I do not use prednisone | |
| Other | |
| Initiation of steroid-sparing agent with corticosteroids (R2, Q5) | No |
| Yes | |
| Other | |
| Does the initial dosage of steroids differ depending on indication (active arrhythmias vs cardiomyopathy)? (R2, Q6) | No, I use the same dosing range no matter what the indication |
| Yes, I choose a higher dose for arrhythmias | |
| Yes, I choose a higher dose for cardiomyopathy | |
| Other | |
| Duration of immunosuppressive therapy (R2, Q7) | 1 y |
| 2 y | |
| Indefinitely | |
| Other | |
| Does the duration of IS therapy differ depending on indication (active arrhythmias vs cardiomyopathy)? (R2, Q8) | No |
| Yes | |
| Other | |
| Evaluation of response to IS therapy (R1, Q15) | 12-Lead ECG |
| SAECG | |
| Ambulatory ECG (Holter or event monitor) | |
| Echocardiogram | |
| Cardiac FDG-PET scan | |
| Cardiac MRI | |
| Brain natriuretic peptide | |
| Troponin levels | |
| Cardiac radionuclide stress test | |
| Other | |
| Consideration for placement of an AICD (R1, Q10) | Survival from a sudden cardiac death event |
| Positive EP study | |
| Presence of arrhythmias on ambulatory ECG (Holter or event monitor) | |
| Abnormal cardiac MRI | |
| Abnormal cardiac PET scan | |
| Do not have access to EP | |
| I do not advocate implanting AICDs | |
| Other | |
| Consideration for placement of a lone pacemaker (R1, Q11) | Low-grade conduction blocks |
| High-grade conduction blocks | |
| Do not have access to EP | |
| I do not advocate implanting pacemakers | |
| Other |
Round 1 responses rate, 31 of 42; round 2 response rate, 27 of 31. Bold indicates agreement ≥ 70%; italic font indicates agreement ≥ 50% but < 70%. AICD = automated implantable cardiac defibrillator; IS = immunosuppressive; TNF = tumor necrosis factor. See Table 2 legend for expansion of the other abbreviations.