Unifocal premature ventricular complex ablation for recurrent ventricular fibrillation in a post–myocardial infarction patient with acquired long QT

Premature ventricular complexes (PVCs) can trigger life-threatening ventricular arrhythmias in structural heart disease. [1]This case highlights the importance of recognizing PVC-triggered VF in high-risk patients with structural heart disease.In patients with structural heart disease and recurrent VF from unifocal PVCs, catheter ablation has been proven to be safe, effective and potentially lifesaving option. [1][2]] CASE REPORT:History Of Presentation: A 53-year-old gentleman presented to the emergency room with complaints of shortness of breath and epigastric discomfort for 3 days.He also reported a history of fever and cough three days prior for which he received oral treatment on an outpatient visit.Upon arrival, his vital signs were as follows: blood pressure 160/82 mmHg, heart rate 102 beats per minute, respiratory rate 36 breaths per minute, and oxygen saturation 98% on 4 liters of oxygen.Examination revealed no jugular venous distention (JVD), a Glasgow Coma Scale (GCS) score of 15/15, bilateral crackles up to the mid-zones, normal S1 and S2 heart sounds without J o u r n a l P r e -p r o o f Key-Teaching points: 1. QT-prolonging drugs can trigger malignant arrhythmias: Azithromycin-induced QTc prolongation led to PVC-triggered VF in this patient with structural heart disease.2. Overdrive pacing is a lifesaving bridge: Temporary pacing at 120 bpm suppressed recurrent PVCs and VF when antiarrhythmics failed.3. Catheter ablation + ICD ensures long-term survival: Ablation of fascicular PVCs reduced arrhythmic burden, and ICD implantation provided secondary prevention.