Myocardial Remission in High Burden Outflow Tract Premature Ventricular Complex-Induced Cardiomyopathy after Radiofrequency Catheter Ablation: Case Report
Keywords:
PVC-induced cardiomyopathy, Premature ventricular complex, Catheter ablation, Myocardial remission, Heart failure
Abstract
Background: Premature Ventricular Complex (PVC)-induced Cardiomyopathy (PVC-CMP) is a spectrum of dilated cardiomyopathy.
Case Illustration: A 51-year-old female patient who was diagnosed with high suspicion of PVC-CMP underwent successful 3D mapping radiofrequency catheter ablation with a good result. Post-ablation 24-hour ECG-Holter evaluation showed a significant reduction of PVC burden. Echocardiographic evaluation 5 months post-ablation showed improvement in left ventricular systolic function parameters. The presence of high-burden PVC with a typical outflow tract origin could raise suspicion of a specific PVC-CMP aetiology. PVC burden emerged as a major predictor of the development of CMP. Several criteria can be used to identify PVC-CMP. Our case met those descriptive criteria, increasing the likelihood of PVC-CMP.
Conclusion: PVC-CMP should be considered in patients with dilated cardiomyopathy who are accompanied by frequent outflow tract origin PVC (> 10 % burden). Early recognition of PVC-CMP is essential, as removal of the primary aetiology improves ventricular structure and function.
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2. Martin CA, Lambiase PD. Pathophysiology, diagnosis, and treatment of tachycardiomyopathy. Heart. 2017;103(19).
3. Kim DY, Kim SH, Ryu KH. Tachycardia induced Cardiomyopathy. Korean Circ J. 2019;49(9).
4. Smiseth OA, Donal E, Boe E, Ha JW, Fernandes JF, Lamata P. Phenotyping heart failure by echocardiography: imaging of ventricular function and haemodynamics at rest and exercise. Eur Heart J Cardiovasc Imaging. 2023;24(10).
5. Smiseth OA, Torp H, Opdahl A, Haugaa KH, Urheim S. Myocardial strain imaging: How useful is it in clinical decision making? Eur Heart J. 2016;37(15).
6. Ellis ER, Josephson ME. Heart failure and tachycardia-induced cardiomyopathy. Curr Heart Fail Rep. 2013;10(4).
7. Hasdemir C, Ulucan C, Yavuzgil O, et al. Tachycardia-induced cardiomyopathy in patients with idiopathic ventricular arrhythmias: The incidence, clinical and electrophysiologic characteristics, and the predictors. J Cardiovasc Electrophysiol. 2011;22(6)
8. Yao J, Xu J, Yong YH, Cao KJ, Chen SL, Xu D. Evaluation of global and regional left ventricular systolic function in patients with frequent isolated premature ventricular complexes from the right ventricular outflow tract. Chin Med J (Engl). 2012;125(2)
9. Bozkurt B, Colvin M, Cook J, et al. Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement from the American Heart Association. Circulation. 2016;134(23).
10. Ailoaei, Ș., Șorodoc, L., Ureche, C., Sîtari, N., Sandu, G., Ceasovschih, A., Grecu, M., Sascău, R.A. and Stătescu, C. (2024), Predictors of Myocardial Fibrosis Detected by CMR in Patients With Idiopathic PVCs. Ann Noninvasive Electrocardiol, 29: e70039. https://doi.org/10.1111/anec.70039
11. Shinbane JS, Wood MA, Jensen DN, Ellenbogen KA, Fitzpatrick AP, Scheinman MM. Tachycardia-induced cardiomyopathy: A review of animal models and clinical studies. J Am Coll Cardiol. 1997;29(4)
12. Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. ESC Scientific Document Group. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022 Oct 21;43(40):3997-4126. doi: 10.1093/eurheartj/ehac262
13. El Kadri M, Yokokawa M, Labounty T, Mueller G, Crawford T, Good E, et al. Effect of ablation of frequent premature ventricular complexes on left ventricular function in patients with nonischemic cardiomyopathy. Heart Rhythm. 2015 Apr;12(4):706-13. doi: 10.1016/j.hrthm.2014.12.017
14. Chung E, Young S, Chen MA. A Case of Premature Ventricular Contractions-Related Cardiomyopathy. Journal of the Royal College of Physicians of Edinburgh. 2021;51(3):262-265. doi:10.4997/jrcpe.2021.311
15. Senapati A, Rojas SF, Kurrelmeyer K, Kassi M, Valderrábano M, Shah DJ, et al. Incessant PVCs and Cardiomyopathy: Think Outside the Box. Methodist Debakey Cardiovasc J. 2020 Apr-Jun;16(2):e1. doi: 10.14797/mdcj-16-2-el
16. Sun Y, Yu X, Xiao X, Dai S, Zhang R, Wang Z, et al. Cardiomyopathy induced by premature ventricular contractions with ventricular escape beats in the compensatory pause: A case report and brief review of the literature. Medicine (Baltimore). 2022 Aug 26;101(34):e30277. doi: 10.1097/MD.0000000000030277
17. Ter Bekke RMA, van Rooij T, Volders PGA, Hocini M. Targeted ablation of the distal Purkinje-myocardium interface for premature ventricular complex-induced cardiomyopathy by delayed Purkinje conduction-induced re-excitation: a case report. Eur Heart J Case Rep. 2025 Jul 16;9(8):ytaf335. doi: 10.1093/ehjcr/ytaf335
18. Panizo JG, Barra S, Mellor G, Heck P, Agarwal S. Premature Ventricular Complex-induced Cardiomyopathy. Arrhythm Electrophysiol Rev. 2018 Jun;7(2):128-134. doi: 10.15420/aer.2018.23.2
19. Latchamsetty R, Bogun F. Premature Ventricular Complex-Induced Cardiomyopathy. JACC Clin Electrophysiol. 2019 May;5(5):537-550. doi: 10.1016/j.jacep.2019.03.013
Published
2026-02-18
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How to Cite
Hendiperdana, M., & Maharani, E. (2026). Myocardial Remission in High Burden Outflow Tract Premature Ventricular Complex-Induced Cardiomyopathy after Radiofrequency Catheter Ablation: Case Report. Indonesian Journal of Cardiology, 47(1). https://doi.org/10.30701/ijc.1844
Section
Case Reports
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