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Updated: Jan 11, 2026

Robotic Ablation of Atrial Fibrillation
Published on: May 29, 2015
Radiofrequency Ablation and Right Purkinje De-Networking for Moderator Band PVC-Induced VF: Broadening the
Eduardo Sanhueza1, Matthew Hanson1, Victor Neira1
1Division of Cardiology, Queen's University, Kingston, Ontario, Canada.
Background:
Idiopathic ventricular fibrillation (VF) can occasionally be triggered by rare premature ventricular complexes (PVCs), including those from the moderator band. Radiofrequency ablation (RFA) is challenging given low PVC burden and anatomic complexity.
Case Summary:
A 36-year-old man with idiopathic VF and an implantable cardioverter-defibrillator for secondary prevention presented with multiple shocks. The VF episodes were triggered by short-coupled PVCs from the moderator band. Despite a low PVC burden (<1%), zero-fluoroscopy catheter ablation was performed. RFA was guided by pace mapping, followed by right-sided Purkinje de-networking. The procedure was uncomplicated, and at 8-month follow-up, the patient remained asymptomatic, with no PVCs or arrhythmic events.
Discussion:
Low-burden PVC-triggered VF is challenging, as conventional pace mapping is limited. Targeted Purkinje network ablation (de-networking) appears to reduce the risk of recurrent VF.
Take-Home-Message:
Pace-mapped RFA combined with ipsilateral Purkinje de-networking may be an effective zero-fluoroscopy strategy for PVC-induced VF, even with low ectopic burden.
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