Introduction:
Anomalous coronary arteries are rare. A malignant course occurs when the anomalous coronary artery takes an interarterial course between the aorta and pulmonary artery (with or without an intramural segment) and is associated with ischemia and an increased risk of sudden cardiac death due to extrinsic compression.1-5 Although the occurrence of ventricular fibrillation (VF) has been reported in patients with malignant anomalous coronary arteries,6ventricular arrhythmias have not been previously localized to the site of an anomalous coronary artery.
We report for the first time the association of a premature ventricular contraction (PVC) originating near an anomalous right coronary artery (RCA), and the successful use of a novel computational mapping algorithm based solely on a standard 12-lead electrocardiogram (ECG) to guide concomitant surgical PVC ablation during coronary artery unroofing.