Idiopathic premature ventricular contractions originating from left ventricular summit successfully ablated from the epicardial approach

Catheter ablation of ventricular arrhythmias originating from the left ventricular summit can be challenging, given the high risk of vascular injury and low success rates during radiofrequency ablation. In case of failed endocardial ablation attempt, ablation from adjacent structures such as the coronary cusps, coronary venous system, and the septal right ventricular outflow tract should be tried as effective alternative approaches, respectively. Epicardial approach is an effective alternative strategy in failed cases. We report on a 45-year-old man with VAs originated from the LVS who underwent an epicardial ablation.