Successful Treatment of Cardiomyopathy Induced by Premature Ventricular Complexes

Background: Idiopathic premature ventricular complexes (PVCs) are consider benign form of cardiac arrhythmia. However, several reports demonstrated that frequent PVCs were associated with left ventricular (LV) dysfunction, increased LV dimensions and cardiomyopathy.
Case Report: A 52 year-old lady with underlying diabetes mellitus, hypertension and dyslipidemia presented with dyspnea and palpitation. Echocardiogram showed Ejection fraction (EF) of 25% with LV systolic diameter 5.2cm and mild functional mitral regurgitation (MR). Holter showed 13657 isolated and couplet PVCs which represent 11.2% of total QRS count in 24 hours. Cardiac MRI showed no inducible ischemia, fibrosis, infarction or inflammation.
Her baseline 12 leads ECG showed superior axis PVCs with left bundle branch block morphology in V1 and transition in V1/V2. Electrophysiology study using 3D mapping system (CARTO, Biosense-Webster) showed two PVCs arising from antero-septal and right postero-septal right ventricular outflow tract. Based on earliest activation and QS signal on unipolar channel together with pace-mapping, both PVCs were successfully ablated.
Since then she was symptom-free and repeated Holter after 3 months showed reduced PVC burden (0.3% over 24hours). Echocardiogram showed improved EF 51%, with, LV systolic diameter 3.8cm with disappearance of MR.
Conclusion: Frequent idiopathic PVCs can lead to cardiomyopathy, which can potentially be reversed with catheter ablation.