Premature peri-Hisian ventricular complexes (PVC) are defined by a His recording at the site of earliest activation or within 10mm distance from the His potential.

We present a case of a 67-year-old male who is referred to our institution for symptomatic and frequent PVC (28% burden in 24-hour Holter monitoring) despite optimal medical treatment. PVC showed a right bundle branch block and inferior axis morphology, with a tall monophasic R wave in DI and aVL, R wave taller in DII and QS in DIII (Fig. 1). Activation mapping of left ventricle with CARTO 3 showed earliest activation of −41ms in the basal septal region with His potential recording. Right ventricle mapping showed a earliest activation of −33ms at with also His potential recording, mapping of the NCC showed −20ms activation without His recording and QS potential in the unipolar channel. Ablation at this site was performed with complete elimination of PVC during follow-up.

The described approach was successful at 6months of follow-up.

Catheter ablation is recommended for the treatment of patients with frequent PVC who remain symptomatic and refractory to medical treatment. Due to the risk of AV block ablation in the peri-Hisian region is challenging, the ablation from adjacent structures such as the NCC is reasonable, even if the activation time is not at the earliest. Unipolar recording in this case was useful to decide the site of ablation; this approach was successful in our patient.