# Pseudo–Left Ventricular Summit Premature Ventricular Contraction in a Patient With Abnormal Intraventricular Conduction

## TL;DR

This paper describes a case where abnormal heart signals misled doctors into thinking a heart rhythm issue originated from the left ventricle, but it actually came from the right ventricle.

## Contribution

The paper introduces the concept of 'pseudo–LV summit PVC' caused by conduction abnormalities and emphasizes the need for systematic mapping in ablation procedures.

## Key findings

- PVCs with LV summit ECG patterns can originate from the right ventricular outflow tract due to conduction abnormalities.
- Systematic endocardial mapping is crucial before considering epicardial ablation in such cases.
- Intraventricular conduction abnormalities can alter PVC morphology and mislead ECG-based localization.

## Abstract

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.