Sustained Ventricular Tachycardia with Preserved Left Ventricular Function and Non-Significant Coronary Lesions in a Patient with a History of Colorectal and Prostate Cancer: Case Report

Abstract

Background: Ventricular tachycardia (VT) typically arises in patients with impaired left ventricular ejection fraction (LVEF). However, VT may also occur in individuals with preserved EF, highlighting the importance of myocardial fibrosis as an arrhythmogenic substrate. Cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE) has emerged as a key tool in identifying such risk beyond EF assessment. Case Presentation: We report the case of a 79-year-old man with a history of colorectal adenocarcinoma (surgically resected) and prostate cancer treated with radiotherapy, admitted with sustained monomorphic non-syncopal VT. Echocardiography showed preserved EF (68%), and coronary angiography revealed no significant stenosis. CMR demonstrated localized basal septal fibrosis, consistent with post-ischemic scar. During hospitalization, the patient developed rectal bleeding, and colonoscopy confirmed ischemic colitis at the colorectal anastomosis site. After multidisciplinary evaluation, a dual-chamber implantable cardioverter-defibrillator (ICD) was implanted for secondary prevention. Follow-up showed no recurrence of sustained VT and stable gastrointestinal status. Conclusion: VT can occur in patients with preserved EF when myocardial fibrosis is present. ICD therapy remains indicated for secondary prevention regardless of EF. This case also underscores the importance of multidisciplinary management in patients with complex comorbidities, including gastrointestinal and oncological conditions.