Exercise induced irregular wide QRS tachycardia with right bundle branch block morphology and extreme QRS axis deviation

Eliyahu Kalfon; Tsafrir Or; Bernard Belhassen

doi:10.1016/j.ipej.2026.02.016

Exercise induced irregular wide QRS tachycardia with right bundle branch block morphology and extreme QRS axis deviation

Eliyahu Kalfon^*
, Tsafrir Or
, Bernard Belhassen

^*Corresponding author for this work

Clinical Departments

Cardiology Department
Western Galilee Medical Center of Nahariya
Hadassah University Medical Centre

Research output: Contribution to journal › Article › peer-review

Abstract

A 29-year-old active woman was referred for evaluation following the development of an irregular wide complex tachycardia with right bundle branch morphology and extreme QRS axis during exercise stress testing. Two main alternative diagnoses are discussed: a) atrial fibrillation with either aberrancy or pre-excitation; b) left ventricular tachycardia originating from the Purkinje system including left posterior fascicle versus posteromedial papillary muscle.

Original language	English
Pages (from-to)	192-194
Number of pages	3
Journal	Indian Pacing and Electrophysiology Journal
Volume	26
Issue number	2
DOIs	https://doi.org/10.1016/j.ipej.2026.02.016
State	Published - 1 Mar 2026

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10.1016/j.ipej.2026.02.016

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abstract = "A 29-year-old active woman was referred for evaluation following the development of an irregular wide complex tachycardia with right bundle branch morphology and extreme QRS axis during exercise stress testing. Two main alternative diagnoses are discussed: a) atrial fibrillation with either aberrancy or pre-excitation; b) left ventricular tachycardia originating from the Purkinje system including left posterior fascicle versus posteromedial papillary muscle.",

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AU - Kalfon, Eliyahu

AU - Or, Tsafrir

AU - Belhassen, Bernard

N1 - Publisher Copyright: Â© 2026 Indian Heart Rhythm Society. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/

PY - 2026/3/1

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N2 - A 29-year-old active woman was referred for evaluation following the development of an irregular wide complex tachycardia with right bundle branch morphology and extreme QRS axis during exercise stress testing. Two main alternative diagnoses are discussed: a) atrial fibrillation with either aberrancy or pre-excitation; b) left ventricular tachycardia originating from the Purkinje system including left posterior fascicle versus posteromedial papillary muscle.

AB - A 29-year-old active woman was referred for evaluation following the development of an irregular wide complex tachycardia with right bundle branch morphology and extreme QRS axis during exercise stress testing. Two main alternative diagnoses are discussed: a) atrial fibrillation with either aberrancy or pre-excitation; b) left ventricular tachycardia originating from the Purkinje system including left posterior fascicle versus posteromedial papillary muscle.

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JO - Indian Pacing and Electrophysiology Journal

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IS - 2

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Exercise induced irregular wide QRS tachycardia with right bundle branch block morphology and extreme QRS axis deviation

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