Ventricular ectopic beats originating from the right ventricular outflow tract (RVOT) is one of the commonest forms of benign ventricular ectopy. But at times RVOT can be the origin of a ventricular tachycardia (VT) which could be either paroxysms of non sustained ventricular tachycardia (NSVT) or sustained ventricular tachycardia. RVOT VT can be induced by exercise and has a left bundle branch block morphology with inferior axis. It is one of idiopathic ventricular tachycardias which can be mapped and ablated by radiofrequency energy, with good results. But some of these foci can have an origin very near the left main coronary artery and caution is needed while ablating these foci to prevent damage to the left main coronary artery. Simultaneous coronary angiography is needed to identify the relation of the mapping catheter to the left main in these situations.
Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London
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