Ablation of Left Ventricular Summit Premature Ventricular Complexes After Bentall Procedure

Ablation of arrhythmias originating from the left ventricular (LV) summit is challenging. Reports of ablation of LV summit premature ventricular complexes (PVCs) after a Bentall procedure are scarce.

A 43-year-old man with frequent PVCs after Bentall procedure was refractory to medication. Electrophysiologic mapping identified the earliest activation site in the left pulmonary sinus, but radiofrequency application there only suppressed the PVCs. Subsequent mapping via a transseptal approach located a more successful site in the subaortic region, which anatomically corresponded to the pulmonary sinus site. Ablation at this site successfully eliminated the PVCs, with no recurrence at 3-month follow-up.

For patients who underwent Bentall procedure, mapping with the standard retrograde aortic approach is unfeasible. A transseptal approach with a reverse S-curve catheter technique can provide effective access to the critical subaortic region of the LV summit, serving as a viable alternative.

This case demonstrates that a transseptal ablation approach is a safe and effective strategy for LV summit PVC ablation in patients with a history of Bentall procedure.