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Review
. 2025 Jun 16;14(12):4261.
doi: 10.3390/jcm14124261.

Idiopathic Ventricular Arrhythmias Originating from the Left Ventricular Summit: A Diagnostic and Therapeutic Challenge

Raffaele Falco  1 , Chiara Tognola  2 , Lorenzo Gigli  1 , Matteo Baroni  1 , Antonio Frontera  1 , Marisa Varrenti  1 , Alberto Preda  1 , Marco Carbonaro  1 , Roberto Menè  1 , Leandro Fabrizio Milillo  1 , Andrea Sultana  1 , Sara Vargiu  1 , Giulia Colombo  1 , Federica Giordano  1 , Cristina Giannattasio  2 , Patrizio Mazzone  1 , Fabrizio Guarracini  1
Affiliations
Review

Idiopathic Ventricular Arrhythmias Originating from the Left Ventricular Summit: A Diagnostic and Therapeutic Challenge

Raffaele Falco et al. J Clin Med. .

Abstract

Premature ventricular contractions (PVCs) originating from the left ventricular summit (LVS) present a diagnostic and therapeutic challenge due to their complex anatomical location. The LVS includes an epicardial area of the left ventricle bordered by major coronary arteries, which has been increasingly recognized as an arrhythmic focus. Idiopathic ventricular arrhythmias from this area may exhibit specific electrocardiographic characteristics, making accurate localization essential for effective management. Methods: This narrative review explores the primary features of this arrhythmia, emphasizing key diagnostic and therapeutic aspects, including both pharmacological and interventional approaches, considering the recent technological advances in cardiac mapping and ablations. Conclusions: PVCs originating from the left ventricular summit (LVS) exhibit characteristic electrocardiographic features. Prompt recognition of this arrhythmia may facilitate appropriate referral for targeted treatment.

Keywords: arrhythmias; cardiac; catheter ablation; ventricular premature complexes.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PVC from LV summit. An LBBB pattern with an inferior axis and a rapid precordial transition (V3). The “pseudodelta wave” and the MDI > 0.54 suggest an epicardial origin.
Figure 2
Figure 2
LVS approach through coronary sinus.
See this image and copyright information in PMC

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