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Idiopathic RVOT VT — EECC MCQ

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HardArrhythmia & ElectrophysiologyIdiopathic RVOT VTEECC

A 32-year-old woman with a structurally normal heart presents with recurrent symptomatic sustained monomorphic ventricular tachycardia. The VT has a LBBB morphology with an inferior axis. 12-lead ECG in sinus rhythm is normal. Where is the most likely origin of this VT and what is the preferred treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Right ventricular outflow tract; catheter ablation

Explanation lettering: C = shown as A · E = shown as C · A = shown as E

LBBB morphology with inferior axis VT in a structurally normal heart is characteristic of RVOT VT, the most common idiopathic VT. Per the 2022 ESC VA/SCD Guidelines, catheter ablation is recommended (Class I) with high success rates (above 90%). LVOT origin (B) would show RBBB morphology. Bundle branch re-entry (C) occurs in DCM. LPF VT (E) has RBBB with left-axis deviation morphology.

Reference: ESC (2022): Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death