Successful Radiofrequency Ablation of Premature Ventricular Contractions Within a Pulmonary Artery Stent

Abstract

Background: Patients with congenital heart disease often become vulnerable to arrhythmia. Catheter ablation can be appropriate management. However, various anatomic and technical difficulties could be faced.

Case summary: An 8-year-old girl with a history of repaired tetralogy of Fallot and stent insertion at the main pulmonary artery presented with palpitation and dyspnea. A high premature ventricular contractions (PVCs) burden refractory to medications promoted catheter ablation performed through the main pulmonary artery stent.

Discussion: We report the first documented case of successful radiofrequency PVC ablation through a stent. Many challenges needed to be managed, like altered anatomy, presence of the stent, and previous surgical repair, which led to difficult catheter contact and navigation, electrical interference, and shunting of ablation energy.

Take-home messages: This case highlights the feasibility of catheter ablation through a stent. Detecting the appropriate PVC origin guided by meticulous mapping, fluoroscopy, impedance, and temperature promotes safety and efficacy.

Keywords: PVC; catheter ablation; pulmonary artery stent; radiofrequency; right ventricle outflow (RVOT).