Skipping sarcoidosis: When ventricular arrhythmia arises immediately post–permanent pacemaker implantation

Key Teaching Points•Current guidelines suggest that select cardiac sarcoidosis (CS) patients with pacing indications undergo implantable cardioverter-defibrillator (ICD) implantation, given their increased risk of sudden cardiac death.•The formal diagnosis of CS prior to urgent device implant for high-degree atrioventricular (AV) block would be optimal but is limited by the clinical instability, the timing, and the availability of the tools to obtain a timely formal diagnosis.•Further research and discussion is needed regarding what level of evidence of CS is acceptable to implant an ICD directly instead of permanent pacemaker when formal CS cannot be established in a timely manner when a patient presents with potentially life-threatening AV conduction delays. •Current guidelines suggest that select cardiac sarcoidosis (CS) patients with pacing indications undergo implantable cardioverter-defibrillator (ICD) implantation, given their increased risk of sudden cardiac death.•The formal diagnosis of CS prior to urgent device implant for high-degree atrioventricular (AV) block would be optimal but is limited by the clinical instability, the timing, and the availability of the tools to obtain a timely formal diagnosis.•Further research and discussion is needed regarding what level of evidence of CS is acceptable to implant an ICD directly instead of permanent pacemaker when formal CS cannot be established in a timely manner when a patient presents with potentially life-threatening AV conduction delays.