PT - JOURNAL ARTICLE AU - Alrifai, Abdulah AU - Kabach, Mohamad AU - Nieves, Jonathan AU - Chait, Robert 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.