During the past year this 45 year old man has experienced paroxysmal palpitations of increasing frequency and duration, associated with dyspnea and weakness. When free of palpitation he has been in good state of heath and normally active without symptoms:

• Ventricular Tachycardia with the typical pattern of Right Ventricular Out-flow Tract (RVOT) Tachycardia
• (Left Bundle Branch Block morphology with inferior axis, small R waves in V1 and V2)
• Ventricular rate 150/min.
• Retrograde ventriculo-atrial conduction in 3:1 fashion on left side of tracing, and 2:1 fashion on right side of tracing

 

The arrhythmia subsided spontaneously shortly after arrival to the Emergency Department

• Sinus rhythm, 85/min
• Normal ECG

Comments: The patient had undergone investigation that showed no evidence of structural heart disease. He had proven to be intolerant to metoprolol, bisoprolol and flecainide. Verapamil in appropriate dosage had been ineffectual. The patient was therefore admitted to the cardiology ward. An electrophysiology study demonstrated the site of origin of the VT in the posterior region of the right-ventricular outflow tract. Ablation was successfully carried out.