AIMS: Little is known about patients with right bundle branch block (RBBB)-ventricular tachycardia (VT) and arrhythmogenic cardiomyopathy (ACM). Our aims were: (i) to describe electrocardiogram (ECG) characteristics of sinus rhythm (SR) and VT; (ii) to correlate SR with RBBB-VT ECGs; and (iii) to compare VT ECGs with electro-anatomic mapping (EAM) data. METHODS AND RESULTS: From the European Survey on ACM, 70 patients with spontaneous RBBB-VT were included. Putative left ventricular (LV) sites of origin (SOOs) were estimated with a VT-axis-derived methodology and confirmed by EAM data when available. Overall, 49 (70%) patients met definite Task Force Criteria. Low QRS voltage predominated in lateral leads (n = 37, 55%), but QRS fragmentation was more frequent in inferior leads (n = 15, 23%). T-wave inversion (TWI) was equally frequent in inferior (n = 28, 42%) and lateral (n = 27, 40%) leads. TWI in inferior leads was associated with reduced LV ejection fraction (LVEF; 46 ± 10 vs. 53 ± 8, P = 0.02). Regarding SOOs, the inferior wall harboured 31 (46%) SOOs, followed by the lateral wall (n = 17, 25%), the anterior wall (n = 15, 22%), and the septum (n = 4, 6%). EAM data were available for 16 patients and showed good concordance with the putative SOOs. In all patients with superior-axis RBBB-VT who underwent endo-epicardial VT activation mapping, VT originated from the LV. CONCLUSIONS: In patients with ACM and RBBB-VT, RBBB-VTs originated mainly from the inferior and lateral LV walls. SR depolarization and repolarization abnormalities were frequent and associated with underlying variants.

2nd Department of Medicine Department of Cardiovascular Medicine 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Arrhythmia Section Cardiology Department Hospital Clínic Universitat de Barcelona and IDIBAPS Institut d'Investigació August Pi i Sunyer Barcelona Spain

Cardiology and Arrhythmology Clinic Department of Clinical Special and Dental Sciences Marche Polytechnic University Ancona Italy

Cardiology Department at Hospital Universitario y Politecnico La Fe and Research Group on Inherited Heart Diseases Sudden Death and Mechanisms of Disease La Fe Valencia Spain

Cardiology Department Hospital Universitario Virgen de las Nieves Granada Spain

Cardiovascular Sciences and Cardiology Clinical Academic Group St George's University Hospitals NHS Foundation Trust London UK

Center for Biomedical Network Research on Cardiovascular Diseases Madrid Spain

Centre Hospitalier Universitaire d'Amiens Picardie Amiens France

Department of Cardiology Erasme University Hospital Université Libre de Bruxelles Brussels Belgium

Department of Cardiology Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Cardiology Jesselson Integrated Heart Center Shaare Zedek Medical Center Jerusalem Israel

Department of Cardiology University Heart Center Zurich Zurich Switzerland

Department of Cardiology University Medical Center Utrecht The Netherlands

Department of Genetics University Medical Center Utrecht The Netherlands

Division of Cardiology Policlinico Casilino Roma Italy

Division of Cardiology University of Torino Department of Medical Sciences Città della Salute e della Scienza Hospital Torino Italy

Heart Institute Hadassah University Hospital Jerusalem and Sackler School of Medicine Tel Aviv University Kyriat Hadassah PO Box 12000 91120 Jerusalem Israel

Hôpital Cardiologique du Haut Lévêque and Université Bordeaux LIRYC Institute Bordeaux France

Institut de Cardiologie Groupe Hospitalier Pitié Salpêtrière and Sorbonne Université 47 83 boulevard de l'Hôpital 75013 Paris France

IRCCS San Raffaele Scientific Institute Milan Italy

Leviev Heart Institute Sheba Medical Center Tel Hashomer and Sackler School of Medicine Tel Aviv University Tel Aviv Israel

Netherlands Heart Institute Utrecht The Netherlands

Service de Cardiologie CHU de Nantes Nantes France

The Department of Cardiology The Heart Centre Copenhagen University Hospital Rigshospitalet and Section of genetics Department of Forensic Medicine Faculty of Medical Sciences University of Copenhagen Copenhagen Denmark

Université de Lille et Institut Cœur Poumon CHRU Lille Lille France

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