Combined Transapical Transcatheter Aortic Valve Implantation and PVC Ablation in a High-Risk Cardiomyopathy Patient: a case report

Background Frequent premature ventricular contractions (PVCs) and valvular dysfunction are established contributors to worsening heart failure. Case summary We present a 67-year-old male with dilated cardiomyopathy, severe aortic regurgitation, and unifocal left ventricle-originated PVCs (37.8% burden) refractory to guideline-directed medical therapy and cardiac devices. Due to high surgical risk, a combined transapical transcatheter aortic valve implantation and PVC ablation was performed. Postoperatively, PVCs were eliminated, left ventricular ejection fraction improved from 35% to 55%, and cardiac dimensions normalized significantly. Discussion This case highlights the feasibility of a single apical approach for addressing both valvular and arrhythmic pathologies in high-risk patients, offering a novel strategy to mitigate heart failure progression.