Case 5:
A 44 year old man with previously normal ventricular function and a high
burden of symptomatic premature ventricular contractions (PVCs) from
various RV sites despite multiple previous ablations presented for
repeat ablation. He was found to have a small area of endocardial
low-voltage (<1.5 mV) at the anterior RV outflow region. PES
from the RV apex and basal septum with up to 4 extrastimuli following a
drive cycle length of 350ms did not induce any ventricular arrhythmia in
the baseline state or following isoproterenol and epinephrine infusions.
However, PES from the inferior RV free wall readily induced sustained
monomorphic VT. Subsequent cardiac MRI and FDG PET were consistent with
sarcoidosis. The details of his clinical course have been previously
reported.12