ArticleJACC. Case reports2026
Posteroseptal RVOT PVCs in a Clockwise-Rotated Congenital Heart: A Left-Sided Illusion.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundElectrocardiography (ECG) localization of ventricular arrhythmias assumes normal cardiac anatomy. In cases of adult congenital heart disease, surgical remodeling can confound traditional algorithms. CASE: A 26-year-old male with repaired pulmonary atresia and ventricular septal defect presented with a 17% premature ventricular complexes burden. The ECG showed right bundle branch block morphology, inferior axis, and positive precordial concordance, classically suggesting a left-sided origin. However, cardiac computed tomography revealed extreme clockwise rotation, displacing the right ventricular outflow tract (RVOT) posteriorly. MANAGEMENT: Guided by imaging, mapping prioritized the RVOT. Earliest activation (-20 ms) and a 99% pace-map match were identified at the posteroseptal RVOT. Ablation resulted in immediate suppression, confirming the right-sided origin.
conclusionsThis "left-sided illusion" demonstrates that anatomical rotation can cause right-sided foci to mimic left-sided origins. Integrating cross-sectional imaging with ECG interpretation is critical for guiding ablation strategies in the adult congenital heart disease population.
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