Ventricular contraction timing2/26/2024 ![]() ![]() This line of reasoning has been important, both to identify clinical risks and to try to “back calculate” something about the underlying mechanism. Subsequent investigations have focused on distinguishing risk factors for the development of cardiomyopathy in patients with PVCs. Importantly, the authors proposed that this small experience supported a differential susceptibility between patients to develop cardiomyopathy, as a clear dose response could not be established. Seven of the eight had successful ablation and LV function normalised in all seven. Although the mean PVC burden in this study was >17,000/24 h, two of the eight with depressed LV function had <6,000/24 h. 5 From a group of 27 patients referred for ablation of right ventricular outflow tract PVCs, eight had depressed LV function. An early description of the potential effect of catheter ablation on PVC-induced cardiomyopathy by Yarlagadda et al. 4Īs in most things in medicine, the details of all of these qualifiers are important. 3 The salient features of how we think of this diagnosis may be summarised as follows: (1) LV dilatation and reduction in systolic function, either in the absence of pre-existing cardiac pathology or a recognised further reduction in LV function in the setting of pre-existing heart failure in association with (2) frequent PVCs and (3) full or partial resolution of LV dysfunction with successful treatment of PVCs. The concept of PVC-induced cardiomyopathy was first proposed by Duffee and coworkers, who observed a small group of patients with cardiomyopathy recover normal left ventricular (LV) function after pharmacological suppression of frequent PVCs. It must be stressed that much of what follows represents my point of view, as observational studies supply most of the available data. The purpose of this review is to discuss what is understood about this syndrome, its prognosis and how catheter ablation may alter its natural history. The tendency of general cardiologists seems to be undertreatment (after coronary heart disease is excluded) and the tendency of electrophysiologists may be overtreatment, particularly regarding the potential development of PVC-induced cardiomyopathy. Anecdotally, there is considerable confusion regarding the application of therapy in general and catheter ablation specifically in all three of these indications. The three indications for treatment are symptom control, to prevent recurrence in PVC-triggered ventricular fibrillation and to potentially reduce the effects of PVC-induced cardiomyopathy. For an important minority, PVCs represent an important medical condition that requires treatment. 1 Although PVCs in the setting of advanced structural heart disease have independent negative prognostic implications, 2 the majority of PVCs are quite benign, associated with neither symptoms nor signals of future harm. Premature ventricular contractions (PVCs) are very common cardiac arrhythmias, detected on up to 75 % of Holter monitors of ambulatory patients.
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