Multimodality imaging, electrophysiologic, electroanatomic, and histopathologic characterization of atrial sarcoidosis presenting with sinus arrest and.

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Multimodality imaging, electrophysiologic, electroanatomic, and histopathologic characterization of atrial sarcoidosis presenting with sinus arrest and reentrant right atrial flutter Ashwin Bhaskaran, MBBS, Saurabh Kumar, BSc(Med)/MBBS, PhD, Eddy Kizana, MBBS, PhD, Stuart P. Thomas, MBBS, PhD, William W.B. Chik, MBBS, PhD HeartRhythm Case Reports Volume 4, Issue 10, Pages 469-474 (October 2018) DOI: 10.1016/j.hrcr.2018.06.014 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 A: Telemetry strip demonstrating a prolonged sinus pause. B: Junctional bradycardia with frequent prolonged sinus pauses. C: A 12-lead electrocardiogram showing junctional bradycardia with aberrantly conducted premature atrial complexes (Ashman phenomenon). HeartRhythm Case Reports 2018 4, 469-474DOI: (10.1016/j.hrcr.2018.06.014) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 2 A: Cardiac magnetic resonance imaging showing T2 hyperintensity (left) and late gadolinium enhancement (right) of the right atrium (arrows). B: 18F-FDG positron emission tomography with marked multichamber hypermetabolism in the septal and lateral left ventricular walls, basal inferior right ventricle, and posterior right and left atrium (red arrows). C: Right ventricle myocardial biopsy demonstrating patchy stromal fibrosis (black arrows). D: Cytology of fine needle aspiration biopsy of paratracheal lymph node demonstrating epithelioid granuloma (red arrows highlighting histiocytes). HeartRhythm Case Reports 2018 4, 469-474DOI: (10.1016/j.hrcr.2018.06.014) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 3 A: A 12-lead electrocardiogram showing typical counterclockwise atrial flutter. B: Voltage map of the right atrium (posterior-anterior view on the left and anterior-posterior view on the right) demonstrating low-voltage scar (yellow to red) along posterior wall extending inferiorly in the probable region of the sinoatrial node. Purple dots mark the tricuspid annulus. HeartRhythm Case Reports 2018 4, 469-474DOI: (10.1016/j.hrcr.2018.06.014) Copyright © 2018 Heart Rhythm Society Terms and Conditions