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PVC-induced Cardiomyopathy — EECC MCQ

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ModerateCardiac ImagingPVC-induced CardiomyopathyEECC

A 70-year-old woman with HFpEF and 24-hour Holter showing 15% PVC burden has an LVEF of 48%. She has no primary arrhythmia diagnosis. Could the PVCs be contributing to her LV dysfunction?

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Correct answer: D — Yes — PVC-induced cardiomyopathy can develop with PVC burden >10-15%, and catheter ablation of the PVC focus may lead to LVEF recovery

PVC-induced cardiomyopathy is a recognised reversible cause of LV dysfunction caused by chronic frequent PVCs (typically burden >10-15% on 24-hour Holter). The mechanism involves dyssynchronous ventricular activation, increased metabolic demand, and adverse remodelling. The 2022 ESC VA/SCD Guidelines recommend considering catheter ablation of the PVC focus when: (1) PVC burden >10-15%, (2) LV dysfunction is present (or developing), (3) symptoms are significant. Successful ablation often leads to partial or complete LVEF recovery (supporting the diagnosis of PVC-induced cardiomyopathy). This diagnosis should be considered in all patients with otherwise unexplained LV dysfunction and high PVC burden — it is important because it is reversible.

Reference: ESC (2022): Guidelines on VA and SCD Prevention