Relevant Ventricular Septal Defect Caused by Steam Pop During Ablation of Premature Ventricular Contraction

A 62-year-old female patient with highly symptomatic, idiopathic, monomorphic, premature ventricular contraction presented at our institution for further treatment (Figure 1A). Previous medical antiarrhythmic treatment has failed. She had a history of mitral valve repair attributable to rheumatic heart disease 2 years before and paroxysmal atrial fibrillation. Aside from that, transthoracic echocardiogram revealed no structural heart disease. Indication was set for catheter ablation. After transseptal puncture (BRK-0 transseptal needle, St. Jude Medical, St. Paul, MN) a left ventricular electroanatomic activation map of the premature ventricular contraction was done using the CARTO-3 RMT system (Biosense-Webster, Diamond Bar, CA). The site of earliest activation was found in an inferoseptal apical position (Figure 1B and 1C). During radiofrequency ablation at this site with a 3.5-F external irrigated tip …