Intraventricular Left Anterior Descending Artery in a Patient with Ventricular Tachycardia - Innocent Bystander with Significant Procedural Implications.

INTRODUCTION

An intra-right ventricular course of the left anterior descending (LAD) artery is a rare coronary anomaly with uncertain clinical and procedural significance. We describe the use of multimodality imaging to characterize this variant in a patient with ventricular tachycardia and to guide the safe performance of catheter ablation.

CASE PRESENTATION: A 46-year-old White woman presented with ventricular tachycardia and was found on coronary computed tomography angiography to have an intraventricular course of the mid LAD through the right ventricular cavity. Multimodality imaging, including coronary computed tomography angiography and stress cardiac magnetic resonance imaging, demonstrated no evidence of obstructive coronary artery disease, myocardial ischemia, structural heart disease, or myocardial scar. She was ultimately diagnosed with idiopathic right ventricular outflow tract ventricular tachycardia and underwent successful catheter ablation.

DISCUSSION: An intra-right ventricular course of the LAD is a rare coronary variant. In a large coronary computed tomography angiography study, this anomaly was identified in less than 1% of patients. Although its clinical significance is not well understood, this anatomic variant can have important procedural implications for ventricular tachycardia ablation.

CONCLUSIONS

Multimodality imaging is vital in assessing the clinical significance of an anomalous coronary artery and ensuring the procedural safety of ventricular tachycardia ablation.