Left ventricular dysfunction resulting from frequent unifocal ventricular ectopics with resolution following radiofrequency ablation

Abstract

A case is presented, in which asymptomatic but persistent right ventricular outflow tract (RVOT) ectopics resulted in left ventricular (LV) dilatation and systolic dysfunction. The patient underwent extensive investigation with no other cause for the cardiomyopathy being found. Successful ablation of the RVOT ectopic focus resulted in normalization of LV size and function. This case suggests that frequent ventricular ectopy should be considered as a potentially remediable cause of LV dysfunction.

The effect of radiofrequency catheter ablation of frequent premature ventricular complexes and arrhythmia burden on left ventricular function

“…Idiopathic PVCs in patients without structural heart disease (SHD) are usually considered benign [1][2][3]. Successful elimination of the PVCs, either by radiofrequency (RF), catheter ablation, or antiarrhythmic drugs, may improve or even normalise LV systolic function [3][4][5][6][7][8][9]. This retrospective study was done to assess the predictors of improvement of LV function in patients with frequent PVCs.…”

Radiofrequency ablation of “benign” right ventricular outflow tract extrasystoles**Editorials published in the Journal of American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology.

“…Idiopathic dilated cardiomyopathy rarely is associated with extrasystoles having a pattern of left bundle branch block with normal or inferior axis (19), suggesting that RVOT extrasystoles are unlikely a consequence of cardiomyopathy. More importantly, in all these reports, a dramatic improvement of LV function occurred after RFA of ventricular ectopy, suggesting that the cardiomyopathy actually resulted from the ventricular arrhythmia (13)(14)(15)(16)(17)(18). The fact that patients without clinically apparent heart disease who have frequent ventricular ectopy frequently demonstrate subtle hemodynamic and/or angiographic abnormalities was first shown by Kennedy et al (20) more than 20 years ago; however, the site of origin of the ventricular arrhythmia in these patients was not indicated.…”

“…Besides the exceptional occurrence of sudden death, recent case reports have questioned the effects of high-grade RVOT arrhythmias on left ventricular (LV) function. These reports described the occurrence of cardiomyopathy associated with RVOT ectopic activity (13)(14)(15)(16)(17)(18). Idiopathic dilated cardiomyopathy rarely is associated with extrasystoles having a pattern of left bundle branch block with normal or inferior axis (19), suggesting that RVOT extrasystoles are unlikely a consequence of cardiomyopathy.…”

Ventricular extrasystole – induced cardiomyopathy.

“…Svakodnevno raste koliËina dokaza koja povezuje ventrikulske ekstrasistole u inaËe strukturno zdravom srcu, s razvojem dilatacije lijeve klijetke (LV) i sniaeenjem vrijednosti ejekcijske frakciji (EF) LV [2][3][4] . Ovo stanje moaee se uspjeπno lijeËiti medikamentozno 5 ili kateterskom ablacijom, πto rezultira normalizacijom dimenzija i funkcije LV [6][7][8] . ToËna patofiziologija ove bolesti ostaje nerazjaπnjena.…”

“…The scope of evidence is growing on a daily basis linking the ventricular extrasystoles in the structurally normal heart to the development of left ventricular (LV) dilatation and the reduction in LV ejection fraction (EF) [2][3][4] . This condition can be successfully treated by drugs 5 or catheter ablation resulting in the normalization of the LV dimensions and functions [6][7][8] . The exact pathophysio-…”