PT  - JOURNAL ARTICLE
AU  - Abdulah Alrifai
AU  - Mohamad Kabach
AU  - Jonathan Nieves
AU  - Robert Chait
TI  - Left Ventricular Aneurysm Presenting as Bidirectional Ventricular Tachycardia
AID  - 10.31486/toj.18.0023
DP  - 2018 Sep 21
TA  - Ochsner Journal
PG  - 288--290
VI  - 18
IP  - 3
4099  - http://www.ochsnerjournal.org/content/18/3/288.short
4100  - http://www.ochsnerjournal.org/content/18/3/288.full
SO  - Ochsner J2018 Sep 21; 18
AB  - Background: Bidirectional ventricular tachycardia is a rare form of ventricular arrhythmia, characterized by a changing of the mean QRS axis of 180 degrees. Digitalis toxicity is the most common cause of bidirectional ventricular tachycardia; other causes include myocarditis, aconite toxicity, metastatic cardiac tumor, myocardial infarction, and cardiac channelopathies.Case Report: A 73-year-old male with hypertension and a pacemaker implanted for sick sinus syndrome presented with a complaint of substernal chest pressure for several days. He also stated he had had an episode of near syncope. The patient's physical examination was unremarkable; however, electrocardiogram demonstrated sustained bidirectional ventricular tachycardia. Echocardiogram showed severe anterior wall hypokinesis and an estimated ejection fraction of 35%, as well as an apical ventricular aneurysm. Electrophysiology study showed that the apical ventricular aneurysm was the site of the bidirectional arrhythmia. The patient was successfully treated with ventricular tachycardia ablation.Conclusion: This case is a unique example of a patient with bidirectional ventricular tachycardia originating from an apical left ventricular aneurysm that was treated successfully by ablation.