Fig. 5
Images of Case 3 (III-4). a On admission, electrocardiogram showed atrial fibrillation with complete atrioventricular block and a heart rate of 40 bpm. b Monitor electrocardiogram revealed non-sustained ventricular tachycardia. c After the implantation of a cardiac resynchronization therapy defibrillator, electrocardiogram showed pacing rhythm, and a heart rate of 60 ppm. d Chest X-ray showed slight congestion with a cardiothoracic ratio of 60.4%. e Echocardiogram showed a reduced left ventricular ejection fraction of 33.1%, a large left ventricular diastolic diameter of 62.4 mm, and a large left atrial diameter of 45.9 mm. f Cardiovascular magnetic resonance showed late gadolinium enhancement in the left ventricle. g, h Left ventricular endomyocardial biopsy revealed interstitial fibrosis by Hematoxylin and eosin staining (g; magnification, × 50) and Elastica-Masson staining (h; magnification, × 50), but no significant findings of myocarditis, amyloidosis, or sarcoidosis