Multimodality Imaging-Based Therapeutic Decision in Ischemic Cardiomyopathy and Ventricular Tachycardia – a Case Report

Introduction In patients with ischemic heart disease and coronary chronic total occlusion, it is extremely important to assess the presence of myocardial viability via different cardiac imaging techniques in order to predict a potential functional recovery following revascularization. Multimodality cardiac imaging techniques estimate the risk of sudden cardiac death and personalize patient selection for primary prevention implantable cardioverterdefibrillator therapy. Case presentation A 61-year-old patient with a history of an extensive anterior myocardial infarction with conservative management (8 years before the current presentation, when the coronary angiography revealed two-vessel chronic total occlusion) presented to our outpatient service for fast-paced palpitations at home and fatigue. At the time of the index hospitalization, the patient refused coronary artery bypass grafting. During this period, he did not undergo any cardiovascular evaluation, but he did follow the pharmacological recommendations from the initial hospital discharge. Given the detection of multiple premature ventricular contractions and numerous episodes of nonsustained ventricular tachycardia during this medical visit, a multimodal imaging evaluation was conducted, which further guided the implementation of a personalized therapy. Conclusions In patients with ischemic heart failure and coronary chronic total occlusion, presenting with ventricular tachycardia, the therapeutic decision should be based on the results of a multi-modality cardiac imaging evaluation.