Patients with documented VA and LV dysfunction are at increased risk of cardiac events including cardiac death. One study compared outcomes in 22 patients with high-degree atrioventricular block as the initial manifestation of cardiac sar- coidosis, to 31 patients who initially presented with VT and/or HF. After a median follow up of 34 months, the patients who presented with heart block had fewer HF hospitalization, yet fatal car- diac events, including sustained VAs, were similar to those with VT and/or HF, suggesting that the risk of fatal cardiac events is high regardless of the initial clinical presentation.S7.6-13 In the same study, administration of steroids led to some clini- cal improvement, with some patients recovering conduction, yet steroid effectiveness was not uni- versal and did not seem to be protective against adverse cardiac events.S7.6-13 5. Several studies have attempted to evaluate the role of immunosuppression for reducing VA in patients with cardiac sarcoidosis, but results have been inconsistent.S7.6-14 S7.6-16 Furthermore, a worsening of VA has been reported with immunosuppressive therapy (usually glucocorti- coids) in a number of patients, including electri- cal storm developing in some within 12 months of initiating therapy.S7.6-15 One study reported a decrease of arrhythmia burden with steroid ther- apy but only when given in the early stages of the disease; those with advanced LV dysfunction did not experience benefit.S7.6-16 A systematic combined treatment approach was successful in 63% of patient in a series in which medical ther- apy included both steroids and antiarrhythmic medications, followed by radiofrequency cath- eter ablation if needed.S7.6-14 Immunosuppressive therapy may serve a dual purpose beyond arrhythmia effects as it may help stabilize dis- ease progression and prevent further deteriora- tion of LV function, although this has yet to be demonstrated in RCTs. 