Radiofrequency Catheter Ablation for Ventricular Tachycardia With a Right Bundle Branch Block Pattern and Left Axis Deviation

Ventricular tachycardia (VT) with right bundle branch block QRS morphology and left axis deviation originating in the inferolateral apical segment of the left ventricle was found in a 24-year-old man without overt structural heart disease. Intracardiac recordings during VT showed atrioventricular dissociation with the earliest activation at an apical inferolateral site in the left ventricle, where Purkinje fiber potentials were recorded fusing in the ventricular electrogram. Ventricular pacing was performed at this site, and yielded a QRS morphology identical to the VT. Radiofrequency current was applied and resulted in the complete elimination of VT.