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

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

DOI: 10.12659/AJCR.897412

Published: 2016-04-25

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, Aged, Heart Ventricles - diagnostic imaging, Humans, Male, myocardial perfusion imaging, Sympathetic Nervous System - physiopathology, Tachycardia, Ventricular - physiopathology, Tomography, Emission-Computed, Single-Photon