Author + information
- Received February 18, 2019
- Revision received March 27, 2019
- Accepted March 29, 2019
- Published online May 20, 2019.
- Rakesh Latchamsetty, MD and
- Frank Bogun, MD∗ ()
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
- ↵∗Address for correspondence:
Dr. Frank Bogun, Cardiovascular Center, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-5853.
• Frequent PVCs can lead to an often reversible cardiomyopathy, and multiple risk factors for developing a PVC-induced cardiomyopathy have been identified.
• Catheter ablation should be considered as a first-line therapy in the majority of patients with PVC-induced cardiomyopathy.
• The long-term effects of frequent PVCs on the cardiac substrate needs to be further studied, particularly with the emergence of advanced imaging techniques.
• Frequent PVCs can be an indicator for the presence of structural heart disease. Risk stratification in these patients is important and includes detection of scar by CMR imaging and/or programmed ventricular stimulation.
Frequent premature ventricular complexes (PVCs) can cause an often reversible form of cardiomyopathy. The mechanism for the development of premature ventricular complex–induced cardiomyopathy (PIC) continues to be investigated, and animal models as well as human clinical trials suggest ventricular dyssynchrony to be an important component. In addition to a high PVC burden, this review will detail other risk factors associated with the development of PIC. PVCs can be a marker for the presence of other underlying disease and a thorough work-up, including cardiac magnetic resonance imaging with delayed contrast enhancement, needs to be considered to rule out the presence of structural heart disease. Management of PIC can involve catheter ablation or pharmacotherapy. Multicenter studies have shown a high success rate paired with a low complication rate with catheter ablation, and hence catheter ablation has emerged as the preferred therapeutic option for most patients with PIC. Advances in ablation strategy and technology have enhanced our ability to address certain challenging PVC locations. Important challenges that remain include understanding the coexistence of PIC with other forms of cardiomyopathy, whether there is an associated risk of sudden cardiac death, and the long-term effects on cardiac substrate of exposure to frequent PVCs.
Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 18, 2019.
- Revision received March 27, 2019.
- Accepted March 29, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.