A man in his mid-50s with a medical history of nonspecific T-wave abnormalities on electrocardiogram (ECG) reported new-onset chest discomfort, diaphoresis, and shortness of breath that woke him from sleep. Emergency medical services found him to be in a wide complex tachycardia. He was administered a 150-mg bolus of intravenous amiodarone, which failed to terminate his arrhythmia. He ultimately required synchronized cardioversion with a biphasic direct current shock of 100 J. On arrival to the emergency department, his vital signs were stable. Serum electrolyte levels were within normal range and C-reactive protein was less than 6 mg/dL (to convert to milligrams per liter, multiply by 10). High-sensitivity troponin peaked at 1078 pg/mL. His initial 12-lead ECG is shown in Figure 1A. He continued in sinus rhythm with episodes of nonsustained ventricular tachycardia observed on telemetry, as shown in Figure 1B. Cardiac catheterization revealed patent coronary arteries. Cardiac magnetic resonance imaging was remarkable for a dilated right ventricle with moderately reduced systolic function and transmural late gadolinium enhancement with akinesis and dyskinesis involving the right ventricular (RV) free wall and outflow tract extending to the left ventricular (LV) anterior, septal, and apical segments.