Small left ventricular aneurysms in patients with ventricular tachyarrhythmias and normal coronary arteriograms.

With Ventricular Tachyarrhythmias and Normal Coronary Arteriograms To the Editor: Ouyang et al1 report on 4 patients with recurrent exerciseinduced syncope attributable to fast ventricular tachycardia, aneurysms in the inferior-lateral wall of the left ventricle, and a peculiar subepicardial arrhythmogenic substrate. The authors speculate that this presentation may constitute a distinct clinical syndrome and may be amenable to epicardial catheter ablation. A recent study has demonstrated that inflammatory left ventricular microaneurysms, often of viral origin, can be a cause of idiopathic ventricular tachyarrhythmias.2 Additionally, we recently reported a case of left ventricular microaneurysms as a cause of apparently idiopathic ventricular fibrillation in a 36year-old woman.3 Both the study by Chimenti et al2 and our report3 provide examples of ventricular aneurysms of small dimension with different localization in the left ventricle. In contrast, the authors of the present study1 describe aneurysms that are confined to the inferior-lateral wall of the left ventricle in all patients. On closer inspection, their Figure 3 (left ventricular angiography in the right anterior oblique projection in patient 2) shows not 1 but 2 aneurysms during diastole (left) and systole (right).1 The second aneurysm (arrowheads) is located in the anterior wall of the left ventricle. This gives reason to suspect the presence of small aneurysms with different localization in the left ventricle in the patients reported in the present study. Thus, syncope attributable to fast ventricular tachycardia and aneurysms with different localization in the left ventricle (not confined to the inferior-lateral wall), possibly often of viral origin,2 may constitute a distinct clinical syndrome. Some patients may be amenable to epicardial ablation. As multiple aneurysms with different localization in the left ventricle can cause multiple arrhythmogenic foci, long-term follow-up is very important because long-term effects of catheter ablation and clinical outcome in these particular patients are not known.