Pseudo-Left Ventricular Summit Premature Ventricular Contraction in a Patient With Abnormal Intraventricular...

Catheter ablation of premature ventricular complexes (PVCs) remains challenging in select scenarios, particularly those arising from the left ventricular (LV) summit or from epicardial sites.

We report a case of PVCs with a surface electrocardiographic pattern suggestive of LV summit origin but ultimately mapped and successfully ablated in the right ventricular outflow tract (pseudo-LV summit PVC) due to the presence of subtle conduction abnormalities.

Intraventricular conduction abnormalities may have modified ventricular activation patterns, resulting in a pseudo-LV summit morphology. This case highlights the importance of a systematic mapping approach and cautious interpretation of surface ECG criteria, underscoring the need for comprehensive endocardial evaluation before pursuing epicardial ablation.

Intraventricular conduction abnormalities may alter PVC morphology and mislead ECG-based localization. A systematic, stepwise mapping approach-from endocardial to epicardial evaluation-remains essential for accurate diagnosis and effective ablation.