AbstractA 73‐year‐old man with history of pulmonary sarcoidosis was found to have runs of non‐sustained bidirectional ventricular tachycardia (BVT) with two different QRS morphologies on a Holter monitor. Cardiac magnetic resonance delayed gadolinium imaging revealed a region of patchy mid‐myocardial enhancement within the left ventricular basal inferolateral myocardium. An 18‐fluorodeoxyglucose positron emission tomography (FDG‐PET) showed increased uptake in the same area, consistent with active sarcoid, with no septal involvement. Follow‐up FDG‐PET one year later showed disease progression with new septal involvement. Cardiac sarcoidosis, characterized by myocardial inflammation and interstitial fibrosis that can lead to conduction system disturbance and macro re‐entrant arrhythmias, should be considered in differential diagnosis of BVT. BVT may indicate septal involvement with sarcoidosis before the lesions are large enough to be detected radiologically.