Bidirectional ventricular tachycardia caused by a reentrant mechanism with left bundle branch block configuration on electrocardiography

Abstract

Reentrant bidirectional ventricular tachycardia (VT) with left bundle branch block (LBBB) configuration was diagnosed in a 54-year-old woman who showed 2 types of VT: QRS morphologies of LBBB with inferior axis and LBBB with superior axis. The development of VT with a superior axis was preceded by VT with inferior axis and/or both configurations of VT in alternate beats exhibiting bidirectional VT. The electrophysiological study demonstrated reproducible induction of both types of VT by programmed ventricular stimulation and both types of VT were entrained. Using conventional pace mapping and electro-anatomical mapping methods, radiofrequency energy applications at the 2 exit sites of the reentry path successfully terminated both types of VT and the patient was free from VT attacks for more than 15 months.