ICD lead threshold increase - Cardiac Sarcoid

Just got back from the cardiologist.   He interogated my newly implanted biventricular ICD ( Nov 8, 2018) and noted and increase in RV threshold voltage from 1.5 to 2.0V.   What would cause this?  He told me to discuss it with the doctor treating my Sarcoid.   I was diagnosed with Cardiac Sarcoid in 2013 and have had an ICD since then.  Could this be an indication of increased sarcoid activity in my heart?   I have been on prednisone, tappered from 20 to 8 mg/day.  

Can anyone shed some light on this for me.





by DMJ - 2019-02-19 19:56:21

I had a completed heart block due to Sarcoidosis in my heart.  Took a long time to figure out and have a lot of scarring.  I was on Prednisone also, yet after 2 years I said enough.  My last Pet scan still showed a improvement and it may have gone into remission.  My leads were infected and that caused me to get a new pacer and lead replacements in 2016.  My ejection fraction is 32 and I hope in 6 years I can just not get another pacemaker if it gets better.  Sarc is like that, it travels and then can disappear, just hope you don't get a lot of scarring.

Cardiac Sarcoid

by Jmiller - 2019-02-20 11:02:11

Thanks for your comment.   Why did you stop prednisone?    I love my pacemaker, I also have complete heart block and would not be able to do anything without it (resting heart rate low 30's when turned off).   I've been on prednisone for 5 years and don't expect to ever get off it.   My doctor basically said we will wean the level as low as possible hoping to find a level that keeps the Sarcoid under control.   My EF started at ~40%, had increased to 45-50% after being on 10mg/day pred.   As we weaned off to 5mg it appears to be droping, now 40-45%.  Have been back to 8 mg/day hoping to stop any potential decline.   But then yesterday I get the infomation that my lead theshold has increased, still worried I'm declining.

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