A teenage girl presented with recurrent episodes of palpitations for six consecutive years. The resting 12-lead electrocardiogram showed sinus rhythm with no preexcitation or repolarization abnormalities. However, there were continuous multiple runs of non-sustained ventricular tachycardia with right bundle branch block morphologic features. QRS complexes were negative in the rest of the precordial leads (V2-V6) and leads I and avL, but positive in III, avR, and avF, suggesting a left (lateral) ventricular apical origin (Cover image).
The echocardiogram showed no structural abnormalities. The patient was prescribed sotalol, but her symptoms did not improve. Invasive electrophysiological mapping of the left ventricle endocardium demonstrated that the ventricular tachycardia probably originated from the epicardial surface of the left ventricular apex. Cardiac magnetic resonance imaging…
