Ventricular arrhythmias are a major cause of morbidity and mortality in patients with Chagas disease and may occur even before significant left ventricular (LV) systolic dysfunction. Cardiac Chagas disease is characterized by chronic persistent myocardial inflammation, which plays a central role in the genesis of arrhythmias due to irreversible cell damage and scar formation. In addition, active inflammation may increase the automaticity within inflamed areas, or act as a trigger for reentry in the presence of fibrosis. Case Summary: A 68-year-old man presented with an episode of sustained ventricular tachycardia associated to cardiac Chagas disease with ischemic changes on ECG, moderate LV dysfunction and an apical aneurysm on echocardiography. Cardiac magnetic resonance (CMR) imaging showed apical aneurysm and inferolateral late gadolinium enhancement (LGE). Fluorine-18-labeled 2-deoxy- 2-fluoro-D-glucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) and 68-labeled gallium-DOTA-tyr3-Octreotide (68Ga-DOTATOC) PET/CT revealed increased uptake adjacent to hypoperfused or fibrotic areas.2040-01-01