Why the study?
The etiology of reduced LVEF is often multifactorial, making it difficult to isolate a primary cause.
Does PVC ablation improve LVEF and ectopic burden in a patient with severe aortic stenosis and reduced LVEF who remains symptomatic despite TAVR and CRT?
Does PVC ablation improve LVEF and ectopic burden in a patient with severe aortic stenosis and reduced LVEF who remains symptomatic despite TAVR and CRT?
Answers are grounded in this paper and cite their sources.
In a patient with persistent cardiomyopathy following TAVR and CRT, frequent PVCs acted as a reversible cause of left ventricular dysfunction that was successfully treated with ablation.
BACKGROUND: The etiology of reduced left ventricular ejection fraction (LVEF) is often multifactorial, making it difficult to isolate a primary cause. CASE SUMMARY: A patient presented with symptomatic heart failure, severe aortic stenosis, reduced LVEF (35%), and frequent premature ventricular contractions (PVCs). Transcatheter aortic valve replacement led to modest improvement. Syncope later revealed high-degree trifascicular atrioventricular block, prompting cardiac resynchronization therapy (CRT). Despite CRT and optimized medical therapy, LVEF declined, and PVC burden increased. PVC ablation at the left ventricular outflow tract reduced PVC burden to <1%, restoring LVEF to 55%. DISCUSSION: This case highlights the complex interaction between aortic stenosis, conduction disease, and ventricular ectopy. Although transcatheter aortic valve replacement and CRT offered partial benefit, significant improvement occurred only after PVC ablation, supporting the concept of ectopy-induced cardiomyopathy and its reversibility after rhythm control. TAKE-HOME MESSAGE: In persistent cardiomyopathy, PVCs should be considered a reversible cause, warranting stepwise and multimodal management.
No takes yet. Share an insight, caveat, or question.
Costopoulos et al. (2025) studied this question.
Synapse has enriched 10 related papers. Consider them for comparative context: