Fig. 1

CMR imaging in a single-chamber, secondary prevention implanted cardioverter defibrillator (ICD) patient (male, 59 years) presenting with electrical storm (15 adequate episodes of antitachycardia pacing) 24.7 months after device implantation. Diagnostic change (+); management/treatment change (−): pre-CMR referral diagnosis: unknown cardiac disease; post-CMR diagnosis: post-infectious state of chronic myocarditis; pre-CMR treatment plan: ventricular tachycardia ablation; post-CMR treatment plan: targeted ventricular ablation procedure guided by late gadolinium enhancement (LGE)-defined ventricular substrate. A – D, post–contrast cine imaging in all cardiac standard geometries demonstrated regional wall motion abnormality (akinesis of basal inferolateral segment) with near-normal global systolic left-ventricular function (LVEF 52%); E – H, LGE CMR imaging in identical geometries revealed the presence of extensive, strictly epicardial regions of fibrosis. Approximate generator position is indicated by the asterisk