Conduction disorders as the first hallmark of isolated cardiac sarcoidosis in a highly active individual: a case report

Background Cardiac sarcoidosis (CS) is an inflammatory disease with various clinical presentations depending on the extension of cardiac involvement. The disease is often clinically silent, therefore diagnosis is challenging. Case summary We discuss the case of a middle-aged highly active individual presenting with an occasional finding of low heart rate during self-monitoring. The electrocardiogram shows a Mobitz 2 heart block; thanks to multimodality imaging CS was diagnosed and corticosteroid therapy improved cardiac conduction. Discussion To our knowledge this is one of the first documented cases of occasional, early finding of CS in a middle-aged highly active individual who presented with cardiac conduction involvement. Despite the very early diagnosis, multimodality imaging suggested an advanced disease with no edema detection at the CMR. Nevertheless, prompt corticosteroid therapy was able to improve clinical conduction. Although non-sustained ventricular arrhythmias were detected, electrophysiological study allowed to discharge the patient safely without implantable cardioverter defibrillator implantation. Light-to moderate physical activity was allowed at mid-term follow up. A multidisciplinary evaluation should be considered to resume a high intensity training.