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Europace Advance Access published online on October 28, 2009
Europace, doi:10.1093/europace/eup326
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

SHORT COMMUNICATION

QRS alternans during idiopathic ventricular tachycardia originating from the right coronary cusp of the aorta

Takumi Yamada*, Hugh Thomas McElderry, Harish Doppalapudi and George Neal Kay

Division of Cardiovascular Disease, University of Alabama at Birmingham, VH B147, 1670 University Boulevard, 1530 3rd AVE S, Birmingham, AL 35294-0019, USA

A 77-year-old man underwent electrophysiological testing for idiopathic ventricular tachycardia (VT) with QRS alternans exhibiting a left bundle branch block and left inferior axis QRS morphology. Successful radiofrequency catheter ablation was achieved at the site of the earliest ventricular activation in the right coronary cusp. Pacing at this site reproduced an excellent pace map with QRS alternans. Pacing from other sites in the ventricular outflow tracts reproduced neither an excellent pace map nor QRS alternans. This case demonstrates that VT with a single origin and multiple exits in the aortic root may exhibit QRS alternans.

Key Words: Idiopathic ventricular tachycardia, QRS alternans, Multiple exits, Right coronary cusp, Pace mapping

* Corresponding author. Tel: +1 205 975 4724, Fax: +1 205 975 4720, Email: takumi-y{at}fb4.so-net.ne.jp

Manuscript submitted 17 July 2009. Accepted after revision 27 September 2009.


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