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Christiane Jungen, Gwendolyn von Gogh, Christiane Schmitt, Pawel Kuklik, Boris Hoffmann, Kenichi Nakajima, Stephan Willems, Janos Mester, Christian Meyer
(Department of Cardiology – Electrophysiology, University Heart Centre, University Hospital Hamburg-Eppendorf, (‘DZHK’ German Centre for Cardiovascular Research, partner site Hamburg/Kiel/Luebeck, Germany), Hamburg, Germany)
Am J Case Rep 2016; 17:280-282
Regional cardiac sympathetic denervation causes electrophysiological heterogeneity and has been found to be a predictor of potentially lethal VT.
CASE REPORT: We present the case of 69-year-old patient admitted with recurrent ventricular tachycardia and a history of anterior myocardial infarction. In line with Tc-99m-MIBI-SPECT perfusion imaging, electroanatomical mapping revealed extensive LV anterior scarring as detected by low-voltage areas. Surprisingly, I-123-MIBG-SPECT showed an extensive deficit of sympathetic innervation inferior (mismatch) and anterolateral (match).
CONCLUSIONS: Combination of electroanatomical mapping with tomographic imaging of innervation and perfusion might improve our understanding of the neural trigger of VT after myocardial infarction or substrate-based catheter ablation.