It all starts with the ECG: cardiac MRI in combination with electrophysiological study to stratify arrhythmic risk in a patient with non-ischemic cardiomyopathy and preserved LVEF.

A 45-year-old male, hypertensive and obese presented with a 3-months history of short episodes of intermittent palpitations. Clinical examination was unremarkable; however, the electrocardiogram documented major right bundle branch block and the presence of fragmented QRS in all precordial leads. His echocardiography documented a dilated left ventricle, with mild systolic dysfunction and moderate biventricular reduction of the global longitudinal strain. On angiography, the epicardial coronary arteries were normal. A cardiac MRI revealed diffuse transmural fibrotic lesions with non-ischemic pattern of the ventricles, suggestive of chronic myocarditis. The electrophysiological study induced two ventricular tachycardia morphologies which were ablated and an ICD for sudden cardiac death primary prevention was implanted. Fortunately, at 6 months follow-up our patient had no ICD therapies and reported an alleviation of symptoms. [ABSTRACT FROM AUTHOR]