skip to main content

PVC Worsening Pre-existing HFrEF — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateHeart FailurePVC Worsening Pre-existing HFrEFEECC

A 60-year-old man with HFrEF (LVEF 25%) on optimal GDMT has Holter monitoring showing frequent NSVT and 25% PVC burden. His LVEF has been declining despite GDMT. Could the PVC burden be contributing to his LV dysfunction?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Yes — PVC-induced cardiomyopathy can worsen pre-existing HFrEF when PVC burden exceeds 10-15%; catheter ablation of the PVC focus may improve LVEF by eliminating the arrhythmic contribution to LV dysfunction, even in the presence of underlying cardiomyopathy

PVC-induced cardiomyopathy can occur in isolation (structurally normal heart develops LV dysfunction from chronic high PVC burden) OR can worsen pre-existing cardiomyopathy (additive injury). In established HFrEF: (1) high PVC burden (>10-15%) may be a reversible contributor to declining LVEF; (2) PVC-mediated dyssynchrony (PVCs cause abnormal activation patterns similar to LBBB pacing); (3) the 2022 ESC VA/SCD Guidelines recommend PVC ablation (Class I) when: high PVC burden is suspected of causing or worsening LV dysfunction; (4) after successful ablation in HFrEF patients with high PVC burden, LVEF improvement of 5-15% is commonly observed (even in the presence of underlying cardiomyopathy); (5) if LVEF does not improve after PVC elimination, the dysfunction is attributable to the underlying cardiomyopathy. This underscores the importance of evaluating PVC burden in all HFrEF patients with declining LVEF despite GDMT.

Reference: ESC (2022): VA/SCD Guidelines