Mismatch Between Cardiac Perfusion, Sympathetic Innervation, and Left Ventricular Electroanatomical Map in a Patient with Recurrent Ventricular Tachycardia.
BACKGROUND
Regional cardiac sympathetic denervation causes electrophysiological heterogeneity and has been found to be a predictor of potentially lethal VT.


METHODS
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.
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.
Christiane
C
Jungen
Department of Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Gwendolyn
G
von Gogh
Department of Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Christiane
C
Schmitt
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.
Pawel
P
Kuklik
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.
Boris
B
Hoffmann
Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan.
Kenichi
K
Nakajima
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.
Stephan
S
Willems
Department of Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Janos
J
Mester
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.
Christian
C
Meyer
D000368:Aged; D006321:Heart / Q000294:innervation*; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D055414:Myocardial Perfusion Imaging; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D017180:Tachycardia, Ventricular / Q000503:physiopathology*; D015899:Tomography, Emission-Computed, Single-Photon