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A 27-year-old female presented to our emergency department in ventricular tachycardia. During her workup, she was found to have an extremely rare giant aneurysmal left anterior descending artery (LAD) ending in a coronary fistula to the right ventricle (RV). After stabilization, a variety of treatment options were considered, as there is no standard first-line treatment., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Nicholas Peterman et al.)