LAUSR

Clinical re-review of all suspected ARVC cases should always be performed, especially when more Introduction The underlying etiology of ventricular tachycardia (VT) is essential for developing proper risk stratification and treatment strategies. Assessment of an underlying diagnosis such as ischemic or nonischemic disease, genetic cardiomyopathies such as arrhythmogenic right ventricular cardiomyopathy (ARVC), and structural VTs such as mitral valve prolapse or disjunction is critical for each patient presenting with initial and recurrent VT. Sometimes more than 1 etiology coexists and the onus is on the electrophysiologist to determine where and what the cause of the clinical VT is. This requires scrutinization of all available clinical information including prior and presenting electrocardiogram, cardiac imaging (echo, magnetic resonance imaging [MRI], computed tomography [CT]), stress testing, and the presence or absence of coronary artery disease. In addition to the preprocedural data, interprocedural data such as structural defects noted with intracardiac echocardiogram further sharpen the clinician’s ability to diagnosis and effectively treat VT. We present a unique case of a VT arising from a submitral aneurysm in a patient who was initially misdiagnosed as VT secondary to ARVC. minor criteria are met, in light of the more recent scientific statements for diagnostic criteria and enhanced imaging techniques. Case report A 65-year-old man with a past medical history notable for ARVC was transferred to our hospital for management of recurrent intracardiac defibrillator (ICD) shocks in VT storm. Notably, 15 years prior to presentation he suffered an outof-hospital arrest. A baseline right bundle branch block was