Catheter ablation of left ventricular outflow tract premature ventricular complexes in a patient with mechanical aortic and mitral valves

Background. Catheter ablation of premature ventricular complexes (PVCs) originating from the left ventricular outflow tract (LVOT) is highly challenging in patients with dual prosthetic mechanical cardiac valves due to restricted ventricular access and the high risk of valvular damage. We report a case of successful catheter ablation of symptomatic, frequent PVCs from LVOT in a patient with mechanical aortic and mitral valves. Case Report. A 39-year-old man with previous mechanical aortic and mitral valve replacements presented with symptomatic, frequent PVCs in a bigeminal pattern refractory to medical therapy. Baseline electrocardiography suggested an LVOT origin. Given the double mechanical valves, standard retrograde or transseptal approaches into the left ventricle were precluded. Instead, electroanatomical mapping was safely restricted to the aortic root, superior to the mechanical aortic valve. Intracardiac echocardiography (ICE) was used throughout the procedure for continuous visualization of cardiac structures and precise catheter positioning. Applying radiofrequency energy within the right coronary sinus of Valsalva immediately suppressed the PVCs. Post-procedural ICE ruled out pericardial effusion as well as mechanical valvular interference. At the 12-month clinical follow-up, the patient remained entirely free of PVC recurrence. Conclusion. This case demonstrates that catheter ablation of PVCs from LVOT is feasible and safe in patients with mechanical aortic and mitral valves using a supravalvular approach, strictly guided by ICE.