Premature ventricular contraction-induced dilated cardiomyopathy: a case report

摘要

Background Premature ventricular complexes (PVCs) are ectopic heartbeats caused by early myocardial depolarizations, previously thought to be benign. Recent studies found high PVC burden above 24% can induce or contribute to cardiomyopathy and heart failure. We present a case of PVC-induced dilated cardiomyopathy (DCM). Case summary A 68-year-old woman was admitted with pneumonia after an overseas trip with a preceding viral respiratory tract infection. An initial chest X-ray was suggestive of cardiomegaly. A transthoracic echocardiogram (TTE) revealed DCM with global systolic dysfunction (left ventricular ejection fraction 30%) without valvular lesions. Biochemistry and coronary angiography were normal. Clinical deterioration occurred despite medical therapy. A 24-h Holter monitoring detected 27% PVCs, which was thought to have caused DCM. As an alternative to cardiac resynchronization therapy and an implantable cardiac defibrillator for primary prevention, ablation of the PVC focus led to complete suppression of ectopy. Post-procedure TTEs and Holter monitoring showed normalized systolic function and low PVC burden. Discussion Because high PVC burden can lead to cardiomyopathy and heart failure, suppression of PVC should be considered to restore ventricular function for patients with structural heart disease and frequent symptomatic PVCs. This case highlights that PVCs may be a modifiable risk factor for heart failure that can be successfully treated with pharmacological therapies or catheter ablation. Close Cardiomyopathy , Case report , Catheter ablation , Dilated cardiomyopathy , Heart failure , Premature ventricular complexes For the podcast associated with this article, please visit https://academic.oup.com/ehjcr/pages/podcast Learning points High premature ventricular contraction burden appear to be independently associated with left ventricular dysfunction, ventricular dyssynchrony, and subsequent heart failure. Ventricular ectopic ablation may be useful treatment to suppress premature ventricular contraction and restore ventricular function for patients with structural heart disease and frequent symptomatic premature ventricular contractions.