2 The absence of (S) wave in left precordial leads is also typ- ical of left VA originating from coronary cusps, in contrary to VA originating in the left ventricular myocardium resulting in late right ventricular activation and typical right bundle branch pattern with prominent (S) wave in V5-V6 [4]. The presence of rS pattern in D1 [5] is also more prominent in LCC-VA whereas it is less marked or even absent in right coronary or non-coronary cusp; this is due to late activation of the right ventricle in case of LCC-VA because LCC is located more to the left and more posterior compared to the two other cusps. When invasive electrophysiological studies could not be performed, surface EKG becomes of utmost importance to diagnose this type of VAs and accordingly to diﬀerentiate it from other VAs, especially non-outﬂow tract VA which have a more critical prognosis if they are not treated adequately [6]. Outﬂow tract VA have a favorable prognosis in the majority of patients, and the risk of sudden cardiac death is low when no structural heart disease is documented [6]. When medical therapy is not suﬃcient to control VA, transcatheter ablation procedures may oﬀer a deﬁnite therapy to most patients. 4. Conclusion LCC-VAs have special EKG characteristics and accordingly they can be diagnosed with suﬃcient accuracy based on surface EKG. Limitations in this presented case, there was no invasive electrophysi- ological procedure performed due to patient denial and so intracavitary mapping of the arrhythmia is lacking. Conﬂict of Interests The authors declare that there is no conﬂict of interest. Consent References According to our institutional Ethics Committee, a written consent was obtained from the patient before proceeding with this paper. [1] T. Yamada, H. T. McElderry, H. Doppalapudi et al., “Idiopathic ventricular arrhythmias originating from the aortic root. Prev- alence, electrocardiographic and electrophysiologic characteris- tics, and results of radiofrequency catheter ablation,” Journal of the American College of Cardiology, vol. 52, no. 2, pp. 139–147, 2008. [2] L. Kanagaratnam, G. Tomassoni, R. Schweikert et al., “Ventric- ular tachycardias arising from the aortic sinus of Valsalva: an under-recognized variant of left outﬂow tract ventricular tachy- cardia,” Journal of the American College of Cardiology, vol. 37, no. 5, pp. 1408–1414, 2001. [3] M. E. Krebs, P. C. Krause, E. D. Engelstein, D. P. Zipes, and W. M. Miles, “Ventricular tachycardias mimicking those arising Case Reports in Medicine from the right ventricular outﬂow tract,” Journal of Cardiovas- cular Electrophysiology, vol. 11, no. 1, pp. 45–51, 2000. [4] K. R. Chun, K. Satomi, K. H. Kuck, F. Ouyang, and M. Antz, “Left ventricular outﬂow tract tachycardia including ventricular tachycardia from the aortic cusps and epicardial ventricular tachycardia,” Herz, vol. 32, no. 3, pp. 226–232, 2007. [5] H. Hachiya, K. Aonuma, Y. Yamauchi et al., “Electrocardio- graphic characteristics of left ventricular outﬂow tract tachy- cardia,” Pacing and Clinical Electrophysiology, vol. 23, no. 11, pp. 1930–1934, 2000. [6] O. Durin, C. Pedrinazzi, P. Agricola, G. Romagnoli, G. Donato, and G. Inama, “Idiopathic ventricular tachycardia: clinical char- acteristics and management,” Giornale Italiano di Cardiologia, vol. 11, no. 10, supplement 1, pp. 27S–31S, 2010.