A case of successful ablation of ventricular ectopic focus from the superior tricuspid annulus through the internal jugular vein: a case report

BACKGROUND: Symptomatic premature ventricular complexes (PVCs) are a common clinical problem. Although most of ventricular ectopic foci can be easily ablated, some are very challenging and require special manoeuvers. This case report presents an approach to improve electrode stability during ablation. CASE SUMMARY: A 19-year-old Asian male patient presented with frequent symptomatic PVCs having an inferior axis, left bundle branch morphology, and R/S transition in V4. Structural heart disease was excluded by echocardiography and general blood tests were normal. The treatment with a class Ic antiarrhythmic (ethacizine) over 2 months was ineffective and the patient was admitted for radiofrequency ablation. Activation mapping revealed a PVC focus in the superior part of the tricuspid annulus, but the femoral access approach resulted in frequent dislocation of the ablation tip. An internal jugular vein approach though resulted in improved stability and successful elimination of the PVC. DISCUSSION: In cases with PVCs from the superior portions of the right heart, stability of the electrode may be improved by a jugular venous access.