Electroanatomical Mapping in the Differentiation Between Arrhythmogenic Right Ventricular Cardiomyopathy and Cardiac Sarcoidosis in a Patient With Ventricular Tachycardia Storm

Document Type : Case Report


1 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.


A 36-year-old man with frequent episodes of ventricular tachycardia (VT) was referred to our hospital for ablation due to the suspicion of sarcoidosis and arrhythmogenic right ventricular cardiomyopathy in cardiac magnetic resonance imaging. After implantable cardioverter-defibrillator implantation, the patient presented with VT storm, without any endocardial scar and with an extensive epicardial scar in voltage mapping. Consequently, he underwent epicardial VT ablation. (Iranian Heart Journal 2021; 22(1): 112-116)


Cesario DA, Vaseghi M, Boyle NG, et al. Value of high-density endocardial and epicardial mapping for catheter ablation of hemodynamically unstable ventricular tachycardia. Heart Rhythm. 2006; 3:1–10.
Garcia FC, Bazan V, Zado ES, Ren JF, Marchlinski FE. Epicardial substrate and outcome with epicardial ablation of ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation. 2009; 120:366–375.
Bai R, Di Biase L, Shivkumar K, et al. Ablation of ventricular arrhythmias in arrhythmogenic right ventricular dysplasia/cardiomyopathy: arrhythmia- free survival after endo-epicardial substrate based mapping andablation. Circ Arrhythm Electrophysiol. 2011; 4:478–485.
Santangeli P, Di Biase L, Lakkireddy D, et al. Radiofrequency catheter ablation of ventricular arrhythmias in patients with hypertrophic cardiomyopathy: safety and feasibility. Heart Rhythm. 2010; 7:1036–1042.
Dukkipati SR, d’Avila A, Soejima K, et al. Long-term outcomes of combined epicardial and endocardial ablation of monomorphic ventricular tachycardia related to hypertrophic cardiomyopathy. Circ Arrhythm Electrophysiol. 2011; 4:185–194.
Sosa E, Scanavacca M, D’Avila A, Bellotti G, Pilleggi F. Radiofrequency catheter ablation of ventricular tachycardia guided by nonsurgical epicardial mapping in chronic Chagasic heart disease. Pacing ClinElectrophysiol.1999; 22:128–130.
Sosa E, Scanavacca M, d’Avila A. Transthoracic epicardial catheter ablation to treat recurrent ventricular tachycardia. Curr Cardiol Rep. 2001; 3:451–458.
Reimer KA, Lowe JE, Rasmussen MM, Jennings RB. The wavefront phenomenon of ischemic cell death. 1. Myocardial infarct size vs duration of coronary occlusion in dogs. Circulation. 1977; 56:786–794.
Jincun G, Faguang Z, Weibin H, Yan W, Kang D, Tung R. Outside-in subepicardial dissection during percutaneous epicardial ventricular tachycardia ablation. Circ Arrhythm Electrophysiol. 2016; 9.
Valles E, Bazan V, Marchlinski FE. ECG criteria to identify epicardial ventricular tachycardia in nonischemic cardiomyopathy. Circ Arrhythm Electrophysiol. 2010; 3:63–71.
Berruezo A, Fernández-Armenta J, Andreu D, et al. Scar dechanneling: new method for scar-related left ventricular tachycardia substrate ablation. Circ Arrhythm Electrophysiol. 2015;8:326–336
Ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial. Lancet. 2010; 375:31–40.
Mahdiye Mehdinejad Shani, Majid Haghjoo, Ali Vasheghani, Shabnam Madadi, Seyede Neda Hashemi, Reyhaneh Shabani, Nafise Taraghi Evaluation of Diagnostic Characteristics and Predictors of Appropriate ICD Therapy in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy, IHJ, 2016