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25 April 2016 : Case report  Germany

Mismatch Between Cardiac Perfusion, Sympathetic Innervation, and Left Ventricular Electroanatomical Map in a Patient with Recurrent Ventricular Tachycardia

Challenging differential diagnosis, Educational Purpose (only if useful for a systematic review or synthesis), Rare coexistence of disease or pathology

Christiane JungenABCDEF, Gwendolyn von GoghABCDF, Christiane SchmittABCDF, Pawel KuklikBCDEF, Boris HoffmannABCDF, Kenichi NakajimaACDF, Stephan WillemsACDEF, Janos MesterABCDEF, Christian MeyerABCDEF

DOI: 10.12659/AJCR.897412

Am J Case Rep 2016; 17:280-282

Abstract

BACKGROUND: 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.

Keywords: Heart - innervation, Heart Ventricles - diagnostic imaging, myocardial perfusion imaging, Sympathetic Nervous System - physiopathology, Tachycardia, Ventricular - physiopathology, Tomography, Emission-Computed, Single-Photon

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923