Enveloped Ablation: A Strategy for Managing Outflow Tract PVCs With an R Wave Pattern Break in Lead V2

Outflow tract premature ventricular contractions (OT‐PVCs) with an R wave pattern break in Lead V2 (PBV2) pose significant treatment challenges due to their refractory nature and complex anatomical origins. A 56‐year‐old male with drug‐resistant palpitations underwent detailed electroanatomical mapping using a microcatheter to identify the earliest activation site. This precision mapping was crucial for directing the ablation strategy accurately. The “enveloped ablation” technique was employed, involving multisite, low‐power ablations surrounding the critical activation site, tailored to address the unique electrical and structural characteristics of OT‐PVCs with a PBV2. This case highlights the importance of accurate mapping and tailored ablation strategies in managing OT‐PVCs with PBV2.