PMC3963755_01
Baseline ECG shows T inversions in V1-V3.
gcsp-2013-261-g001.jpg
PMC3963755_01_gcsp-2013-261-g001.jpg
fig1
Her initial workup started with an electrocardiogram (ECG) (Figure 1).
ECG during exercise testing.
gcsp-2013-261-g002.jpg
PMC3963755_01_gcsp-2013-261-g002.jpg
fig2
An exercise treadmill test (ETT) was done which resulted in symptomatic non-sustained salvos of VT with a left bundle inferior axis (LBIA) with peak exertion and into recovery (Figure 2).
Endocardial activation duration map of right ventricle.
gcsp-2013-261-g003.jpg
PMC3963755_01_gcsp-2013-261-g003.jpg
fig3
The total endocardial activation duration (EAD) was noted to be 63 msec with the earliest activation being at the apex and the latest at the outflow tract (Figure 3).
Spontaneous triplet PVCs with first fusion beat. Note: V3 and V4 were inadvertently reversed during the study.
gcsp-2013-261-g004.jpg
PMC3963755_01_gcsp-2013-261-g004.jpg
fig4
She had multiple spontaneous polymorphic premature ventricular contractions (PVCs) at baseline prior to placement of catheters which were both left bundle superior axis (LBSA) and LBIA morphologically (Figure 4).
Spontaneous VT on isoproterenol infusion.
gcsp-2013-261-g005.jpg
PMC3963755_01_gcsp-2013-261-g005.jpg
fig5
VT with LBSA pattern as shown in (Figure 5). Ventricular programmed stimulation with double and triple extra stimuli resulted in multiple runs of non-sustained ventricular tachycardia, the longest of which was 20 beats in duration.
Induction of polymorphic VT on ventricular stimulation on isoproterenol.
gcsp-2013-261-g006.jpg
PMC3963755_01_gcsp-2013-261-g006.jpg
fig6
Multiple runs of non-sustained ventricular tachycardia were induced with varying morphologies and occasional polymorphic ventricular tachycardia (Figure 6).