Ventricular fibrillation: ablation of a trigger?

We report the case of a patient with recurrent ventricular fibrillation (VF) and no evidence of structural heart disease. VF was consistently initiated by a relatively early-coupled premature ventricular contraction with identical morphology on each occasion. Treatment with antiarrhythmic agents failed to suppress the arrhythmia. Electrophysiologic testing showed high-frequency potential at the earliest activation site, and radiofrequency ablation resulted in abolition of the ventricular ectopy with no further VF recurrence. Suppression of VF arising from focal triggers in patients with frequent ventricular ectopy and normal heart can be achieved with catheter ablation, but further studies are needed to evaluate the prevalence of such a mechanism.