In our case report we describe a catheter ablation in a patient with symptomatic, drug-refractory atrial fibrillation using the new CT image integrating mapping technology. Using image integration an arrhythmogenic right inferior pulmonary vein was revealed which was not found during conventional 3-dimensional mapping. Thereby we want to demonstrate potential impacts on safety and effectiveness of ablation strategies using an image integration technology, especially in cases of difficult anatomic variations.

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In patients with a low or intermediate probability of a coronary artery disease, ultrafast computer tomography (CT) of the coronary arteries and bypass grafts offer a novel approach for the evaluation of the coronary anatomy. The presented case impressively demonstrated the capability of ultrafast CT to show precisely the extent and localisation of a bypass artery stenosis in a patient with mild chest discomfort but negative stress testing. However, widespread screening of coronary artery disease with non-invasive imaging modalities can not be recommended until validated in larger studies that a complete visualization of all coronary arteries and bypass grafts can be achieved.

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Although takotsubo cardiomyopathy is rather rare, it should be considered as a relevant differential diagnosis mimicking acute myocardial infarction. Despite a generally good prognosis under conservative treatment, complications are reported in 17.7% of all cases in the literature. Therefore, intensive treatment and monitoring are mandatory.