21 August 2026
: Case report 
Left Ventricular Summit Ventricular Tachycardia Identified by Electrocardiographic Pattern Recognition and Managed With Radiofrequency Ablation
Challenging differential diagnosis, Management of emergency care, Rare disease
Mariana Goes Moreira ABCDEF 1, Carina Abigail Hardy ABD 1, Leandro Menezes Alves da Costa ACD 1, Ana Carolina Menezes Borsoi ACD 1, Rodrigo Goldenstein Schainberg ACD 1, Anna Beatriz Gori Montes ACD 1, Rafael Amorim Belo Nunes ACD 1, Thiago Midlej Brito ACD 1, Daniel Castanho Genta Pereira ACD 1, Roger Pereira de Oliveira
ACD 1, Thiago Luis Scudeler ABCDEF 1*
DOI: 10.12659/AJCR.953321
Am J Case Rep 2026; 27:e953321
Table 1 Chronological timeline of presentation, diagnostic evaluation, ablation therapy, and follow-up.
| Date | Events |
|---|---|
| Date of presentation / Day 1 | A 66-year-old man presented with a 24-hour history of dizziness and palpitations but was hemodynamically stable. Initial 12-lead ECG showed sinus rhythm with frequent bigeminal PVCs with left bundle branch block-like morphology, inferior axis, and early precordial transition |
| Day 2 | Continuous intensive care unit monitoring revealed frequent ventricular arrhythmia, including PVC and sustained and nonsustained ventricular tachycardia, and 24-hour Holter monitoring demonstrated a ventricular ectopic burden of approximately 65%. Echocardiography showed preserved ventricular function. Coronary angiography excluded obstructive coronary disease. Amiodarone was initiated because of symptoms and high arrhythmia burden |
| Day 3 | Cardiac magnetic resonance imaging showed no myocardial fibrosis or scar. Amiodarone was discontinued before the electrophysiological study to reduce interference with arrhythmia inducibility |
| Day 4 | Electrophysiological study with isoproterenol infusion induced ventricular tachycardia. Activation mapping demonstrated the earliest ventricular activation in the left ventricular summit region at a safe distance from the coronary arteries |
| Day 4 | Radiofrequency ablation was performed using a stepwise approach from the great cardiac vein and adjacent left ventricular outflow tract and left coronary cusp sites, resulting in immediate suppression of ventricular arrhythmia |
| 30-Day follow-up | The patient remained asymptomatic, with no recurrence of ventricular arrhythmia on follow-up Holter monitoring |
| Abbreviations: ECG, electrocardiogram; PVC, premature ventricular complexes. | |