Radiofrequency ablation has been demonstrated to be a low-risk and effective treatment for eliminating premature ventricular complexes (PVC).^1,2 The retrograde transaortic approach is a widely used access route for the mapping and ablation of ventricular arrhythmias arising from the left ventricle, including the papillary muscles.¹ It has been reported that some complications were associated with the retrograde transaortic approach, including iatrogenic aortic dissection, coronary damage, valve leaflets damage, complete atrioventricular block and so on.^1,3 However, acute ischemic stroke (AIS) associated with the retrograde transaortic manipulation during radiofrequency ablation of PVC was rarely reported.⁴ In this case report, we shared a case of AIS encountered after the retrograde transaortic manipulation, during a procedure of PVC ablation.

A 66-year-old woman (Height 164cm, Weight 72Kg) was referred for radiofrequency ablation of frequent PVC (Figure 1A), after the treatment of which by medication had been ineffective. She had a history of palpitation for one year. Her PVC burden was 14.5%, with a total of 12735 PVCs during the 24-hour Holter. Regular examination confirmed the diagnosis of hypercholesteremia (total cholesterol 6.08mmol/L, low-density lipoprotein cholesterol 4.16 mmol/L). No other disease (hypertension, diabetic mellitus, stroke) was recorded. Before the procedure, transthoracic echocardiography revealed the patient had normal cardiac diameters and normal left ventricular ejection function (68%).