We described interpolated bigeminy ventricular premature contractions due to cardiac compression by a large left pleural effusion during exercise test. A 68-year-old man was admitted to the hospital for further examination of chest oppression. His history included a rheumatoid arthritis for more than 20 years and multiple admissions to the hospital. He had been on indomethacin (75 mg/daily) in partial remission for more than 1 year. Laboratory findings of thoracentesis fluid revealed that the cause of pleural effusion was rheumatoid arthritis. He had no diabetes mellitus, thyrotoxicosis, myopericarditis, ischemic or valvular heart disease.