In this case, ventricular premature beats and transient myocardial ischemia were captured during the operation. According to the literature, the equipment of IVL can produce low and rapidly decayed energy (8–10µJ) and activate stretching activation channels in the cardiac conduction system. Furthermore, myocardium can be depolarized, leading to arrhythmia [6]. In this case, IVL induced isolated ventricular premature beats, which did not necessitate medical intervention.

It has been reported that ventricular premature beats can exacerbate the progression of atherosclerosis and enhance plaque instability by affecting hemodynamics. In this case, the presence of ventricular premature beats may affect the blood flow supply of coronary arteries to some extent [7]. Repeated interruption of blood flow leads to ischemia further, which causes clinical symptoms and ST-segment changes. The operator did not interrupt the pulse delivery, but continued to lengthen the interval for restoring distal blood supply. Fortunately, when the interval was extended to 30s, the patient had no chest pain or ST-segment changes. Follow-up after discharge also indicated a good prognosis of the patient.