Author + information
- P. Cheema and
- C. Perzanowski
High frequency premature ventricular contractions(PVC) can lead to PVC cardiomyopathy(CM). However, in ischemic-CM, the effects of high density PVCs is less well known. This report illustrates the positive results of ablating incessant left aortic cusp PVCs in a patient with worsening ischemic-CM.
A 61-year-old male with history of coronary artery bypass grafting presented with worsening shortness of breath. Telemetry and electrocardiogram revealed a high burden of unifocal PVCs with triggered automaticity(Fig.A). His left ventricular ejection fraction(LVEF) had declined over two years to 15-20%. The decision was made to proceed with PVC ablation to alleviate his heart failure. Interrogation of the RVOT and CS excluded these structures as sources of ectopy. Mapping the aortic cusps of Valsalva revealed a focus of earliest activation on the left coronary cusp. Ectopy was successfully eliminated with ablation. On ten day follow up the patient’s ejection fraction had increased to 30% with improvement to NYHA class II.
Even in cases of ischemic-CM with chronically reduced LVEF, culprit left coronary cusp PVC ablation can result in improvement of left ventricular systolic function and NYHA class.