QRS fragmentation and T-wave inversion as factors of vulnerability to recurrent ventricular tachycardia.

Clinical manifestation of late onset recurrent monomorphic ventricular tachycardia (VT) in patients with normal left ventricular ejection fraction may elude diagnosis despite elaborate testing. This report describes a 67-year-old woman with structurally normal heart who presented with recurrent VT in the absence of predisposing factors. Repeated extensive diagnostic testing, including magnetic resonance imaging and coronary angiography, did not disclose any abnormality. An implantable cardioverter-defibrillator was placed following noninducibility of the third episode of VT at electrophysiological study. Patient's 12-lead electrocardiogram in normal sinus rhythm revealed permanent QRS fragmentation as well as T-wave inversions as the only warning features that heralded the impending appearance of recurrent VTs over the course of 5 years follow-up.