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A 65 year old man was referred because of an episode of syncope preceded by palpitations. He had a four month history of chest pain and palpitations unrelated to exercise. On admission, ECG showed sinus rhythm without repolarisation abnormalities. Echocardiography Doppler evaluation was normal. In an exercise thallium-201 test the patient achieved 76% of the predicted maximal heart rate with a 4.6 Mets workload. A 2 mm ST segment depression was observed in the anterolateral leads without chest pain. A thallium-201 scan showed myocardial perfusion abnormalities involving the anterior segment. The Holter recording revealed two runs of non-sustained monomorphic ventricular tachycardia (VT) at 160 beats/min, which the patient felt as palpitations but without angina. Programmed stimulation with ventricular pacing and extrastimuli did not induce VT. Left coronary angiography showed a significant systolic milking effect in the second portion of the left anterior descending …