INCIC cases ·
Inferior septal enhancement at 54: what is your diagnosis?
A 54-year-old man. Cardiac MR: cine, late enhancement, perfusion and native T1.
Case by Julián Vega Adauy · jvega@incic.org
Late enhancementInferior septum
What is your diagnosis?
Answer
Post-ablation lesion of a left fascicular ventricular tachycardia
Post-ablation lesionVentricular tachycardia
The patient had undergone radiofrequency ablation of a left fascicular ventricular tachycardia in March 2023. Late enhancement shows transmural enhancement at the junction of the mid inferoseptal and mid inferior segments, with a hypointense central “core”, consistent with a post-ablation lesion.
Pearls
- A dark centre is not always microvascular obstruction. A radiofrequency lesion leaves a hypointense central core surrounded by transmural enhancement, which can mimic an infarct with microvascular obstruction.
- The location gives it away. Left fascicular ventricular tachycardia is ablated in the inferior septum of the left ventricle, right where this lesion sits.
- Always ask about previous procedures. A history of ablation completely changes how a focal enhancement is read.