Coexisting fascicular ventricular tachycardia and papillary muscle ventricular tachycardia in the setting of coronary artery disease in a master athlete.

A 73-year old male developed syncope during a bicycle race. Exercise stress testing demonstrated non-sustained ventricular tachycardia (NSVT) and ischemic changes. Coronary angiography revealed a 99% occluded right coronary artery which was stented; repeat stress testing demonstrated normal perfusion and NSVT. An electrophysiology study demonstrated left posterior fascicular ventricular tachycardia, which was ablated at two lower turnaround points. NSVT was observed during subsequent stress testing, prompting a repeat electrophysiology study. The inferoseptum and inferior wall were extensively ablated, along with a posteromedial papillary muscle premature ventricular complex. With no further demonstrable NSVT, the patient was cleared to return to competition.