Impact of Scar, Viable Myocardium, and Epicardial Fat on Substrate Identification of Ventricular Tachycardia in a Case with Nonischemic Cardiomyopathy


  • Funding Sources: Takeshi Sasaki, M.D., is funded by the Francis Chiaramonte MD Private Foundation. Dr. Nazarian is funded by a National Heart, Lung, and Blood Institute Career Development Award (K23HL089333).

  • Disclosures: The authors report no relevant conflicts of interest.

Address for reprints: Takeshi Sasaki, M.D., Johns Hopkins University, Carnegie 592C, 600 N. Wolfe Street, Baltimore, MD 21287. Fax: 410-502-4854; e-mail:


A 56-year-old man with nonischemic cardiomyopathy underwent orthotopic cardiac transplantation after endocardial and epicardial radiofrequency catheter ablation for pleomorphic ventricular tachycardia. The myocardial substrate and epicardial fat were comprehensively analyzed with three-dimensional electroanatomic maps, late gadolinium enhanced ex-vivo cardiac magnetic resonance, and histological examination. The association of scar, viable myocardium, and epicardial fat with endocardial and epicardial electrogram voltage and duration was quantitatively defined. This case provides a unique opportunity to explore the reliability of electrical surrogates of scar in nonischemic cardiomyopathy. (PACE 2012;35:e345–e348)