Ablation of idiopathic premature ventricular contractions – exploring the electrophysiologist's toolbox in complex procedures

Idiopathic premature ventricular contractions (PVCs) and ventricular tachycardia occurring in structurally normal hearts correspond to 10% of all patients referred for assessment of ventricular arrhythmias. 1 The clinical course is usually benign and the prognosis is favorable.However, patients with a PVC burden >10% in 24 h Holter monitoring may progress with a potentially reversible form of left ventricular systolic dysfunction.In general, and given a predominately monomorphic target, catheter ablation is more effective than antiarrhythmic drugs to treat PVCs, with success rates exceeding 80%. 2 Most idiopathic PVCs emerge from the outflow tract region of either ventricle, more commonly from the right ventricle outflow tract (RVOT).Other variants of PVC, with similar underlying mechanisms, originate from the aortic root and aortic cusps, the superior basal septum, the aortomitral continuity, mitral or tricuspid inflow tracts, papillary muscles, pulmonary artery and epicardium.