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RVOT VT ECG Features — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyRVOT VT ECG FeaturesEECC

A 30-year-old woman with structurally normal heart presents with palpitations. ECG shows a regular wide-complex tachycardia at 160 bpm with LBBB morphology and right axis deviation. The QRS in V1 shows a tall monophasic R wave. What is the most likely diagnosis?

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Correct answer: B — Right ventricular outflow tract ventricular tachycardia (RVOT VT) — the most common idiopathic VT; LBBB morphology (origin from RV) with inferior axis (outflow tract location); typically benign and amenable to catheter ablation

RVOT VT is the most common idiopathic VT (~70-80% of all idiopathic VTs) arising from the subpulmonary region. ECG features: (1) LBBB morphology (RV origin → activation spreads away from V1); (2) inferior axis (outflow tract = superior location → depolarisation travels inferiorly); (3) precordial transition typically at V3-V4. Unlike ischaemic VT: (1) structurally normal heart; (2) often exercise-induced (catecholamine-sensitive — triggered activity from cAMP-mediated delayed afterdepolarisations); (3) responsive to adenosine (which reduces cAMP — useful diagnostic manoeuvre); (4) responds to beta-blockers and CCBs; (5) excellent catheter ablation results (>90% success). The 2022 ESC VA/SCD Guidelines recommend ablation for symptomatic RVOT VT (Class I) and for high PVC burden causing cardiomyopathy (Class I).

Reference: ESC (2022): VA/SCD Guidelines