Asymptomatic Patient with Complex Exercise-induced Ventricular Tachycardia

Abstract

We present a 58-year-old patient who had planned to start running and bicycling after the winter break. He takes no medications on a regular basis, had no known risk factors, and his blood pressure and cholesterol levels were normal. His GP carried out an exercise bicycle test. Ventricular ectopic beats started at 200 watts at increasing frequency. The exercise bicycle test had to be stopped at 225 watts because of a polytope ventricular tachycardia. A sophisticated diagnostic procedure including CMR enabled us to diagnose asymptomatic myocarditis with oedema as cause of the complex ventricular tachycardia in this patient. EPU ruled out other causes such as Brugada syndrome, ion channel diseases or QT syndromes. The patient had no structural heart disease such as previous myocardial infarction, dilated or hypertrophic cardiomyopathies or arrythmogenic right-heart cardiomyopathy. Coronary angiography ruled out coronary artery disease. This patient was at possible risk of sudden cardiac death while engaging in intensive sport activities. A diagnostic approach including cardiac CMR enabled this potentially life-saving diagnosis.