Coronary sinus mapping to differentiate left versus right ventricular outflow tract tachycardias

Outflow tract ventricular tachycardia (OT-VT) can originate from several different segments of the outflow tract. Various ECG criteria have been proposed for localization of OT-VTs. We present two patients, one with left and one with right OT-VT. We used local ventricular electrograms in the coronary sinus to localize the focus of the OT-VT. Mapping of local ventricular electrograms in the coronary sinus may be a simple and effective method for differentiating right versus left ventricular outflow tract tachycardias. However, the diagnostic value and precision of this method should be evaluated in a series of patients before its implementation in the OT-VT ablation decision algorithm.