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RVOT PVC Ablation — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyRVOT PVC AblationEECC

A 45-year-old man with no structural heart disease presents with recurrent monomorphic PVCs arising from the RVOT on Holter (PVC burden 22%). His LVEF is 50% (previously 58%). He is symptomatic with palpitations. What is the management?

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Correct answer: C — Catheter ablation of the RVOT PVC focus — high PVC burden (>10-15%) with declining LVEF suggests PVC-induced cardiomyopathy; RVOT PVC ablation has >85% success rates and may lead to LVEF recovery

RVOT PVCs are the most common idiopathic PVC type (70-80% of all idiopathic PVCs). When PVC burden is >10-15% with declining LVEF (as in this patient — LVEF dropped from 58% to 50%), PVC-induced cardiomyopathy should be suspected. The ESC 2022 VA/SCD Guidelines recommend catheter ablation for: (1) symptomatic PVCs refractory to/intolerant of beta-blockers/CCBs; (2) high PVC burden (>10-15%) with LV dysfunction; (3) PVCs triggering VF. RVOT PVC ablation has >85-90% success rates with low complication rates. After successful ablation, LVEF typically improves within 3-6 months, confirming the diagnosis of PVC-induced cardiomyopathy. First-line pharmacological options (beta-blockers, non-DHP CCBs) can be tried but have limited efficacy for PVC suppression (~20-30% burden reduction).

Reference: ESC (2022): VA/SCD Guidelines