Syncope and Scar in a Former Elite Basketball Player.

BACKGROUND

Ventricular tachycardia (VT) is a recognized late sequela of prior myocarditis. Accurate diagnosis and risk stratification are essential in athletes presenting with unexplained arrhythmia and scar-related cardiomyopathy.

CASE SUMMARY: A 47-year-old former competitive basketball player presented with exertional syncope. Evaluation revealed mildy elevated troponin levels, apical wall motion abnormalities, and a fixed perfusion defect. Coronary angiography excluded obstructive disease. Cardiac magnetic resonance revealed an inferolateral scar consistent with prior myocarditis. He received an implantable cardioverter-defibrillator. VT was inducible on electrophysiology study, so epicardial VT ablation was attempted but was incomplete given phrenic nerve proximity. Fluorodeoxyglucose uptake on PET/CT initially raised concern for sarcoidosis, but a follow-up PET/CT demonstrated no active inflammation, and initial findings were attributed to postablation inflammation.

DISCUSSION: This case highlights the utility of multimodality imaging in evaluating scar-related VT, the challenges of epicardial VT ablation, and shared decision-making in return to play for athletes with postmyocarditis scar-related arrhythmias.

TAKE-HOME MESSAGES: Multimodality imaging is essential when evaluating scar-related VT in athletes. Epicardial ablation near the phrenic nerve may limit complete substrate modification and affects long-term management decisions.