Introduction:

Premature ventricular complex (PVC) is a frequent diagnostic entity. The underlying cardiac condition is important to establish a prognosis; in the majority of the cases with normal heart, PVCs have a good prognosis; nevertheless, there is a specific morphology of PVC related to serious cardiac issues. The moderator band (MB) PVCs are one of these, described in a normal heart condition; however, MB- PVC can lead to ventricular tachycardia, ventricular fibrillation, or even sudden cardiac death.

Material and methods:

The case of a 25-year-old female patient with very symptomatic, precordial palpitations is presented with a history of presyncope. The workflow showed a normal transthoracic echocardiogram, normal cardiac MRI, and evidence of bigeminy cardiac rhythm even an unstable ventricular tachycardia induction in an electrophysiology study. She was taken to ablation therapy, PVCs from the moderator band were found with the highest activation of -52 ms, the use of intracardiac echocardiogram, and successful ablation in an uncommon PVC location is reported.

Results:

The radiofrequency ablation therapy with 35 watts and 42 oC at the highest activation point on the lateral aspect of moderator band (MB) was successful therapy with the induction of ventricular tachycardia during the application of radiofrequency as a result finish of PVCs.

Conclusions:

In patients with pre-syncopal, syncopal, and even aborted sudden cardiac death secondary to ventricular tachycardia or ventricular fibrillation premature ventricular complexes should be addressed with an invasive strategy as RF ablation therapy with the aim of finish a trigger condition. The moderator band is considered an arrhythmogenic structure, PVCs coming from a MB should be addressed as potential death risk and invasive therapy should be considered earlier than antiarrhythmic drugs.