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Patient
23-year-old man with a tetralogy of Fallot; repair surgery at the age of 6 months; residual pulmonary regurgitation; multiple episodes of palpitations;
Trace
Sinus rhythm at 60 beats/minute; right bundle branch block, very broad QRS (180 ms) and extremely fragmented; followed by wide QRS tachycardia at a rate of 150 bpm; left delay pattern; QRS transition in V3; high positivity of the QRS in the inferior leads and in lead I suggestive of a reentry cycle at the level of the isthmus delimited by the pulmonary infundibulum and the ventricular septal defect closure patch;
Exergue
Patients with a tetralogy of Fallot frequently present ventricular tachycardias with left delay in conjunction with a reentry circuit around anatomical obstacles and involving four different isthmuses.
Patients who have undergone tetralogy of Fallot repair surgery have an increased risk of sudden death and a high incidence of ventricular rhythm disorders has been described.