The Diagnosis and Management of Cardiac Sarcoidosis

Sarcoidosis is a systemic granulomatous inflammatory disorder. Cardiac sarcoidosis (CS) is a clinically important manifestation that may lead to conduction disease, ventricular tachyarrhythmias, heart failure, and sudden cardiac death. The recognition of CS has increased with advances in cardiac imaging; however, its diagnosis and management remain challenging. This review summarizes the contemporary concepts of CS pathophysiology, emphasizing the coexistence of active inflammation and myocardial scarring that develops a dynamic arrhythmogenic substrate. We outline practical diagnostic strategies, including when CS is suspected, the current diagnostic criteria, and the complementary roles and limitations of electrocardiography, echocardiography, cardiac magnetic resonance imaging, and fluorodeoxyglucose positron emission tomography. Management is discussed across three pillars: namely, immunosuppressive therapy centered on corticosteroids, heart failure therapy based on current guidelines, arrhythmia management incorporating pacing, implantable cardioverter-defibrillator therapy, and catheter ablation. Emerging evidence supporting imaging-guided risk stratification beyond conventional left ventricular ejection fraction thresholds has been highlighted.