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Arrhythmias and sudden death
Image challenge
A 54-year-old man with new-onset ventricular fibrillation
  1. Kan Liu,
  2. Jamal Ahmed,
  3. David Feiglin
  1. Division of Cardiology, State University of New York, Upstate Medical University Hospital, Syracuse, New York, USA
  1. Correspondence to Kan Liu, Division of Cardiology, State University of New York, Upstate Medical University, 90 presidential plaza, Syracuse, NY 13202, USA; liuk{at}upstate.edu

Abstract

Clinical introduction A 54-year-old man without significant medical history presented with sudden-onset chest discomfort and multiple episodes of ventricular fibrillation requiring external defibrillation and cardiopulmonary resuscitation. Coronary angiography ruled out significant artery stenosis. Both ventriculography and echocardiography revealed decreased left ventricular ejection fraction (25%). On examination, he was haemodynamically stable. The lungs were clear to auscultation and there was no jugular venous dilation. The cardiac examination revealed a regular rate and rhythm without murmur. Cardiac magnetic resonance (CMR) and 18F-2-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) images were shown (figure 1).

Figure 1
Figure 1

Cardiac magnetic resonance with a T1-weighted inversion recovery image (A) and 18F-2-fluoro-2-deoxyglucose positron emission tomography (B) in a 54-year-old man with new-onset ventricular fibrillation.

Question Which of the following would be the next best step?

  1. Implantable loop recorder

  2. Electrophysiological testing for radiofrequency catheter ablation

  3. Endomyocardial biopsy

  4. Genetic testing

Question

  • Advanced Cardiac Imaging
  • Cardiac Magnetic Resonance (cmr) Imaging
  • Positron Emission Tomographic (pet) Imaging
  • Ventricular Fibrillation
  • Systemic Inflammatory Diseases

http://dx.doi.org/10.1136/heartjnl-2017-312052

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    Footnotes

    • Contributors KL, JA and DF all collected the data and wrote the manuscript.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.