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. 2023 Apr 18;10:1130174. doi: 10.3389/fcvm.2023.1130174

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© 2023 Kubala, Essayagh, Michelena, Enriquez-Sarano and Tribouilloy.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Representative 12-lead surface ECG illustrating multifocal ventricular arrhythmias in the same patient. Frequent premature ventricular complexes of 2 different morphologies were recorded: the first one showing left bundle branch block configuration, V3 transition and inferior axis consistent with an outflow tract site and the second one with right bundle branch block morphology, V5 transition and D2/D3 negative/positive discordance (meaning an opposite depolarization vector along bipolar limb leads II and III being equivalent to a frontal axis of +150 to +210°) suggesting the origin from the anterolateral papillary muscle. Sustained monomorphic ventricular tachycardia (on the right) with a right bundle branch block configuration and superior axis pointing towards the postero-basal left ventricular wall origin was induced with programmed electrical stimulation.