Radiofrequency Ablation of Ventricular Arrhythmias on Bioprosthetic Valve, a Never Found Case Before

INTRODUCTION Although the catheter ablation of frequent premature ventricular complexes (PVCs) from outflow tracts is reported as a highly successful procedure especially in patients with structurally normal hearts, but some cases create a great challenge. Patients with prosthetic valves often are not considered for radiofrequency ablation (RFA) due to risk of possible fatal and nonfatal complications. CASE SUMMARY We describe a rare experience of performing RFA in this high risk, challenging patient. A 76-years-old man with history of coronary artery bypass graft (CABG) due to previous myocardial infarct (MI) and aortic valve replacement with bioprosthetic valve for his aortic insufficiency was referred to our department due to feeling of suffocation and irregularity of pulse during a flight. RF ablation was scheduled for him due to high PVC burden. PVCs showed LBBB morphology, inferior axis with transition in (V3-V4) leads. After failed attempt of RFA through the right outflow tract (RVOT), PVC was terminated from the left coronary cusp. DISCUSSION This case highlights the fact that efficacy of the radiofrequency ablation in patients with bioprosthetic valves is feasible. It has to be emphasized that in such a challenging case, risk of severe complications should be weighted against its benefit.