Therapeutic Effects on Ectopic Burden and LV Ejection Fraction in a Patient With Aortic Stenosis Undergoing TAVR

The etiology of reduced left ventricular ejection fraction (LVEF) is often multifactorial, making it difficult to isolate a primary cause.

A patient presented with symptomatic heart failure, severe aortic stenosis, reduced LVEF (35%), and frequent premature ventricular contractions (PVCs). Transcatheter aortic valve replacement led to modest improvement. Syncope later revealed high-degree trifascicular atrioventricular block, prompting cardiac resynchronization therapy (CRT). Despite CRT and optimized medical therapy, LVEF declined, and PVC burden increased. PVC ablation at the left ventricular outflow tract reduced PVC burden to <1%, restoring LVEF to 55%.

This case highlights the complex interaction between aortic stenosis, conduction disease, and ventricular ectopy. Although transcatheter aortic valve replacement and CRT offered partial benefit, significant improvement occurred only after PVC ablation, supporting the concept of ectopy-induced cardiomyopathy and its reversibility after rhythm control.

In persistent cardiomyopathy, PVCs should be considered a reversible cause, warranting stepwise and multimodal management.