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

BACKGROUND: 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. CASE SUMMARY: 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. DISCUSSION: 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. TAKE-HOME MESSAGES: 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.