Background: Our case highlights the challenging nature of left para-Hisian premature ventricular contractions (PVCs) catheter ablation (CA) and proves that sometimes the compromise between successful ablation and inadvertent atrioventricular (AV) block is the only viable solution for the patient.Case presentation: The case shows an improvement of left ventricular function combining heart failure therapy and CA of the PVC. However, a complete AV block—although with a junctional escape rhythm—could not be avoided. Conclusions The main “take-away” lesson from this case is the importance of prediction of PVC site of origin during preprocedural planning. This is helpful to plan the anatomical approach required for mapping and ablation of these PVCs and to appreciate the risk of the procedure.