Electrocardiographic, electrophysiologic, and anatomical features of ventricular tachycardia originating from noncoronary cusp

In this article, we report 2 young patients (a 15-year-old adolescent girl and a 25-year-old man) with drug-refractory palpitations. Admission electrocardiograms showed runs of ventricular tachycardia with left bundle-branch block morphology, left inferior axis, early precordial QRS transition, and positive QRS complex in lead I. In right ventricular mapping, the earliest activation site was found in the His bundle region. Aortic root mapping showed a very early fractionated ventricular signal with large atrial potential and no His potential in the noncoronary cusp region. Radiofrequency energy application in this region resulted in tachycardia termination within 5 to 10 seconds. During a 3- to 6-month follow-up period, the patients remained asymptomatic, and the electrocardiogram showed no ventricular arrhythmias.