Idiopathic ventricular fibrillation (IVF) is responsible for a sizable part of sudden cardiac death (SCD). Furthermore, it has a high recurrence rate. Recent publications have shown that IVF is often caused by premature ventricular contractions (PVCs) arising from the right ventricular outflow tract (RVOT) or the Purkinje system. Some cases are associated with unbalanced sympathetic cardiac innervation. Some other cases are now believed to be a variant of the Brugada syndrome. Drugs have been shown to be ineffective in the therapy of IVF. The implantable cardioverter defibrillator used to be the only effective therapeutic option. However, radiofrequency (RF) catheter ablation of the trigger (PVCs arising from the RVOT or Purkinje system) has shown to be effective in a considerable number of patients and is now included in the guidelines of secondary prevention of SCD.