Ventricular Tachycardia Originating From the Valsalva Sinus of Left Coronary Cusp

A 21-year-old man presented with frequent episodes of palpitations. A 12-lead ECG revealed an incessant ventricular tachycardia (VT) originating from the outflow tract at a rate of 144 bpm. During electrophysiologic study, clinical sustained VT was repeatedly inducible with programmed ventricular stimulation. An S wave in lead I, a precordial R wave transition in lead V1 and the absence of S wave in leads V5 or V6 conducted the origin of VT as left ventricular outflow and supravalvular region. Pace- and activation-mapping and diastolic activity directed the ablation catheter to the Valsalva of the left coronary sinus. With the guidance of coronary angiography, a single radiofrequency application terminated the VT. No early or late complications or recurrence of VT was observed during follow-up. (Türk Kardiyol Dern Arş 2004; 32: 393-396)