1 INTRODUCTIONRadiofrequency 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.2 CASE HISTORYA 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%).