Introduction:

Most ventricular arrhythmias are related to structural heart disease. When they occur in anatomically normal hearts are known as idiopathic arrhythmias. The highest percentage of premature ventricular complexes (PVC) is originated in the right ventricular outflow tract. However, less frequent sites have been described, such as the tricuspid annulus. Irregular rhythm along with a high percentage of arrhythmic burden (AB) have an important role in the deterioration of left ventricular function.

Objective:

To describe the return to normal ventricular function after PVC radiofrequency ablation (RFA).

Case study:

A 75-year-old man, without relevant history, presented with mild exertion dyspnea and frequent palpitations. The physical examination was normal, the 12-lead electrocardiogram showed premature ventricular contractions with a left bundle branch block (LBBB) pattern and superior axis. A Holter monitoring documented a 35% arrhythmic burden and transthoracic echocardiography demonstrated an LVEF of 40% and global hypokinesia, without valvular heart disease. An electrophysiological study was conducted with three-dimensional mapping that observed the origin of the PVC at the septal tricuspid annulus. RFA was performed in this area, resulting in the immediate disappearance of PVC.

Results:

At 3 months a 24-hour Holter monitoring showed 0.02% of AB and a transthoracic echocardiogram showed LVEF of 65%.

Conclusion:

Premature ventricular contractions originating from the tricuspid annulus are an uncommon cause of tachycardiomyopathy and RFA treatment is safe and effective.

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