Refractory heart failure with LBBB - Pause before CRT.

In this report, we describe complete disappearance of LBBB with normalization of LV function in two patients with cardiac sarcoidosis (CS) after immunosuppressive therapy. Both of these patients were ideal Class IA candidates for CRT (Complete LBBB, QRS ≥ 150ms, EF < 30%). If CS is identified early, immunosuppressive treatment can lead to not only improvement of left ventricular function but also disappearance of the left bundle branch block. Timely diagnosis and management of CS obviated the need of CRT in these patients. It may be reasonable to evaluate all non-ischemic cardiomyopathies for underlying reversible causes prior to CRT implantation.