Intramural left ventricular posterior superior process premature ventricular complex ablation with intracardiac echocardiography.

Intramural premature ventricular complexes (PVCs) are notoriously challenging during catheter ablation due to the depth of the arrhythmogenic substrate. We present a case utilizing intracardiac echocardiography (ICE) integrated with 3D electroanatomical mapping to ablate an intramural PVC in a patient with methamphetamine-associated cardiomyopathy. A 22-year-old female with a history of stimulant use disorder presented with debilitating palpitations and a 46% PVC burden. PVCs originating from the posterior superior process of the left ventricle (PSP-LV) were successfully targeted under ICE guidance. There were no arrhythmia recurrences during follow-up, highlighting ICE as an invaluable tool for mapping and ablating PSP-LV origin PVCs.