Fig. 2.

CMR imaging in a dual-chamber, secondary prevention ICD patient (male, 59 years) presenting with electrical storm (13 adequate shock episodes) 7.2 months after device implantation. Diagnostic change (+); management/treatment change (+): pre-CMR referral diagnosis: hypertensive heart disease; post-CMR diagnosis: acute disease state of cardiac sarcoidosis; pre-CMR treatment plan: ventricular tachycardia ablation; post-CMR treatment plan: medical therapy including steroids. A – D, post–contrast cine imaging in all cardiac standard geometries showed concentric left ventricular (LV) hypertrophy with mildly reduced global LV ejection fraction (LVEF 47%); E – H, LGE CMR imaging (identical geometries) identified extensive, mostly transmural areas of positive LGE in all septal and inferior LV segments with corresponding edema on T2-weighted turbo spin echo imaging (I – L, consecutive short-axis geometries) consistent with an acute inflammatory disease state of cardiac sarcoidosis subsequently being confirmed by endomyocardial biopsy. Approximate generator position is indicated by the asterisk