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A 57-year-old woman presented to our emergency department with a 1-week history of waxing and waning palpitations that worsened and persisted on the day of admission, with associated dizziness and chest discomfort. Hypertension had been diagnosed 2 years earlier and was controlled by an angiotensin receptor blocker. Her family and social history were unremarkable. Her initial blood pressure (BP) was 130/98 mmHg, with a pulse rate of 170 beats/min and a respiration rate of 22 breaths/min. Her electrocardiogram showed a wide QRS tachycardia with left bundle branch block morphology, inferior axis, QRS width ›140 ms, aVL size slightly greater than aVR, and a small r wave of ›0.2 mV in the V2 lead, which suggested that the tachycardia originated from the left superior free wall of the RVOT (Figure 1). Rapid administration of intravenous adenosine and slowly repeated infusions of diltiazem and verapamil had no effect. After Ki-Hun Kim, MD Cardiology Division, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

Ventricular tachycardia originating from the right ventricular outflow tract.