A Case of Premature Ventricular Contraction-Induced Cardiomyopathy

Premature ventricular contractions (PVCs) are often felt to be benign, but can lead to PVC-induced cardiomyopathy when they occur frequently. This case illustrates the progression from asymptomatic PVCs to dilated cardiomyopathy and subsequent recovery following catheter ablation. A 68-year-old male presented with PVCs identified on a routine electrocardiogram. Initial evaluation revealed a PVC burden of 6%, normal left ventricular ejection fraction (LVEF), and no structural heart disease. Over the subsequent 18 months, he remained asymptomatic but developed a 27% PVC burden, global hypokinesis, and a reduced LVEF of 30-35%. Extensive testing (including cardiac catheterization, cardiac MRI, and genetic testing) ruled out ischemic, infiltrative, and genetic causes. Guideline-directed medical therapy (including a beta blocker, angiotensin receptor blocker, and a mineralocorticoid receptor antagonist) was initiated, and the patient abstained from alcohol. Due to persistently high PVC burden and impaired LVEF, he underwent catheter ablation of PVCs originating from the left ventricular summit. Three months later, his PVC burden on 14-day event monitoring fell to <1% and LVEF improved to 40-45%. Over the following two years, the patient underwent additional atrial fibrillation ablation and optimized medical therapy. His LVEF eventually normalized to 55-60% and PVCs remained suppressed. This case illustrates the clinical course and reversibility of PVC-induced cardiomyopathy with appropriate lifestyle changes, medical therapy, and catheter ablation. Early identification and management of frequent PVCs are essential in preventing progression to cardiomyopathy.