Cathether Ablation of Premature Ventricular Complexes from the Left Ventricular Summit Complicated with Acute Coronary Syndrome

Premature ventricular complexes (PVCs) are only clinically significant in a small number of patients. Symptoms are usually accompanied by a significant PVCs burden, which can then cause cardiomyopathy in the long term. Catheter ablation is the therapy of choice in these situations. One of the most challenging foci is the area of the so-called left ventricular summit (LV summit), due to close anatomical connections and consequently a greater possibility of periprocedural complications, including injuries of coronary arteries. We report the case of a patient with atypical chest pain and an acute thrombotic occlusion of the ostial level of the left circumflex artery after a PVCs ablation in the LV summit. An urgent coronary angiography was performed via the right transradial approach and PCI was performed with the implantation of one drug-eluting stent. This case report suggests that it should be standard practice to record a 12-channel ECG of every patient immediately after returning to the ward, regardless of the existence of any symptoms. Considering the low risk of diagnostic coronary angiography (< 1%), we believe that it should be routinely done before and after the planned ablation in the area of the LV summit.