Iatrogenic muscular ventricular septal defect (VSD) is a rare but serious complication of premature ventricular complex (PVC) ablation. Timely diagnosis and management are essential. A 77-year-old woman underwent radiofrequency ablation for symptomatic parahisian PVCs. Radiofrequency applications up to 20 W for 30 seconds were used. Following ablation she presented with worsening heart failure symptoms. Multimodal imaging confirmed a hemodynamically significant irregular VSD measuring approximately 11 × 8 mm at the ablation site. Given her high surgical risk, successful delayed percutaneous closure was performed using an Amplatzer 12-mm muscular VSD occluder leading to resolution of symptoms. PVC ablation requires careful patient selection, particularly when targeting high-risk anatomy. Iatrogenic VSD requires early recognition and individualized management. Multimodal imaging is helpful in diagnosis and guiding management. Percutaneous closure may be an effective alternative to surgical closure. Iatrogenic muscular VSD is a rare but serious complication of seemingly benign PVC ablation intended for symptom relief. Multimodality imaging can be useful for procedural planning, whereas catheter-based closure can be a safe and effective alternative to surgery.