{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T08:13:27Z","timestamp":1779264807420,"version":"3.51.4"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardiac sarcoidosis (CS) is a granulomatous inflammatory disorder that can result in high-grade conduction disease and ventricular arrhythmias, often necessitating permanent pacing and defibrillator support. The transvenous system is particularly challenging in CS with immunosuppression, limited vascular access, and a history of chemotherapy. Traditional transvenous systems may be poorly suited for this immunocompromised population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 52-year-old woman with a history of breast cancer treated with neoadjuvant chemotherapy and biopsy-confirmed systemic sarcoidosis who presented with shortness of breath and was found to have cardiac involvement based on cardiac magnetic resonance imaging and cardiac positron emission tomography findings, leading to immunosuppressive therapy. She developed non-sustained ventricular tachycardia, followed by high-grade and complete heart block, qualifying her for pacing and defibrillator therapy based on current consensus recommendations. Due to limited vascular access (left-sided mastectomy and right-sided port for chemotherapy), cardiac inflammation, and ongoing immunosuppression, an investigational modular cardiac rhythm management (mCRM) system was used, comprising a leadless pacemaker and a subcutaneous implantable cardioverter defibrillator (S-ICD). The patient remained free of new arrhythmias during follow-up and after starting systemic chemotherapy for sigmoid adenocarcinoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The mCRM system manages both bradyarrhythmia and ventricular tachyarrhythmia without the need for intravascular leads. The S-ICD continuously monitors for ventricular arrhythmias and wirelessly commands the leadless pacemaker to deliver anti-tachycardia pacing when indicated, potentially avoiding shocks. By eliminating transvenous components, the mCRM system offers a reasonable approach in CS with immunosuppression and limited vascular access.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag306","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T11:38:46Z","timestamp":1778067526000},"source":"Crossref","is-referenced-by-count":0,"title":["Case report on investigational modular cardiac rhythm management system: wireless communication between leadless pacemaker and subcutaneous defibrillator in cardiac sarcoidosis with limited vascular access"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3766-6546","authenticated-orcid":false,"given":"Sana","family":"Sughra","sequence":"first","affiliation":[{"name":"The Ohio State University Wexner Medical Center , 410 W 10th Ave, Columbus, OH 43210 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralph","family":"Augostini","sequence":"additional","affiliation":[{"name":"The Ohio State University Wexner Medical Center , 410 W 10th Ave, Columbus, OH 43210 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5009-2909","authenticated-orcid":false,"given":"Rami","family":"Kahwash","sequence":"additional","affiliation":[{"name":"The Ohio State University Wexner Medical Center , 410 W 10th Ave, Columbus, OH 43210 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"2026052004013604200_ytag306-B1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s12016-014-8450-y","article-title":"The clinical features of sarcoidosis: a comprehensive review","volume":"49","author":"Judson","year":"2015","journal-title":"Clin Rev Allergy Immunol"},{"key":"2026052004013604200_ytag306-B2","doi-asserted-by":"crossref","first-page":"e1197","DOI":"10.1161\/CIR.0000000000001240","article-title":"Diagnosis and management of cardiac sarcoidosis: a scientific statement from the American Heart Association","volume":"149","author":"Cheng","year":"2024","journal-title":"Circulation"},{"key":"2026052004013604200_ytag306-B3","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1016\/j.jacc.2020.08.042","article-title":"Challenges in cardiac and pulmonary sarcoidosis: JACC state-of-the-art review","volume":"76","author":"Trivieri","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2026052004013604200_ytag306-B4","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1056\/NEJMoa2401807","article-title":"A modular communicative leadless pacing\u2013defibrillator system","volume":"391","author":"Knops","year":"2024","journal-title":"N Engl J Med"},{"key":"2026052004013604200_ytag306-B5","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1016\/j.hrthm.2014.03.043","article-title":"HRS expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis","volume":"11","author":"Birnie","year":"2014","journal-title":"Heart Rhythm"},{"key":"2026052004013604200_ytag306-B6","first-page":"e272","article-title":"2017 AHA\/ACC\/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death","volume":"138","author":"Al-Khatib","year":"2018","journal-title":"Circulation"},{"key":"2026052004013604200_ytag306-B7","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1007\/s00399-018-0602-y","article-title":"The modular cardiac rhythm management system: the EMPOWER leadless pacemaker and the EMBLEM subcutaneous ICD","volume":"29","author":"Tjong","year":"2018","journal-title":"Herzschrittmacherther Elektrophysiol"},{"key":"2026052004013604200_ytag306-B8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jelectrocard.2019.06.001","article-title":"Combination of a leadless pacemaker and subcutaneous defibrillator with nine effective shock treatments during follow-up of 18months","volume":"56","author":"Ljungstr\u00f6m","year":"2019","journal-title":"J Electrocardiol"},{"key":"2026052004013604200_ytag306-B9","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.hrcr.2015.07.009","article-title":"Combination of a leadless pacemaker and subcutaneous defibrillator: first in-human report","volume":"1","author":"Mond\u00e9sert","year":"2015","journal-title":"HeartRhythm Case Rep"},{"key":"2026052004013604200_ytag306-B10","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1002\/joa3.12140","article-title":"Simultaneous leadless pacemaker and subcutaneous implantable cardioverter-defibrillator implantation-when vascular options have run out","volume":"35","author":"Ng","year":"2019","journal-title":"J Arrhythm"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytag306\/68246824\/ytag306.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/5\/ytag306\/68246824\/ytag306.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/5\/ytag306\/68246824\/ytag306.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T08:01:51Z","timestamp":1779264111000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytag306\/8672543"}},"subtitle":[],"editor":[{"given":"Felix","family":"Wiedmann","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Olivia","family":"Braun","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Armen","family":"Kocharian","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":10,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,4,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytag306","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,4,30]]},"article-number":"ytag306"}}