How pure is the honey? Distinguishing premature ventricular complex–induced from premature ventricular complex–worsened cardiomyopathy

Frequent premature ventricular complexes (PVCs) can cause left ventricular (LV) systolic dysfunction or worsen LV function in patients with preexisting structural heart disease. 1 Chugh S.S. Shen W.K. Luria D.M. Smith H.C. First evidence of premature ventricular complex-induced cardiomyopathy: a potentially reversible cause of heart failure. J Cardiovasc Electrophysiol. 2000; 11: 328-329 Crossref PubMed Scopus (190) Google Scholar , 2 Lee G.K. Klarich K.W. Grogan M. Cha Y.-M. Premature ventricular contraction-induced cardiomyopathy: a treatable condition. Circ Arrhythm Electrophysiol. 2012; 5: 229-236 Crossref PubMed Scopus (126) Google Scholar Pharmacologic suppression or catheter ablation can successfully eliminate PVCs and improve LV function in patients with a high PVC burden. 3 Yarlagadda R.K. Iwai S. Stein K.M. Markowitz S.M. Shah B.K. Cheung J.W. Tan V. Lerman B.B. Mittal S. Reversal of cardiomyopathy in patients with repetitive monomorphic ventricular ectopy originating from the right ventricular outflow tract. Circulation. 2005; 112: 1092-1097 Crossref PubMed Scopus (321) Google Scholar Several gaps in knowledge remain regarding this relatively newly recognized cause of nonischemic cardiomyopathy (CM). First, the mechanisms by which frequent PVCs adversely affect LV function are not yet fully defined. 2 Lee G.K. Klarich K.W. Grogan M. Cha Y.-M. Premature ventricular contraction-induced cardiomyopathy: a treatable condition. Circ Arrhythm Electrophysiol. 2012; 5: 229-236 Crossref PubMed Scopus (126) Google Scholar , 4 Huizar J.F. Kaszala K. Potfay J. et al. Left ventricular systolic dysfunction induced by ventricular ectopy: a novel model for premature ventricular contraction-induced cardiomyopathy. Circ Arrhythm Electrophysiol. 2011; 4: 543-549 Crossref PubMed Scopus (112) Google Scholar Second, the predictors of LV recovery after PVC suppression remain unclear. 5 Yokokawa M. Kim H.M. Good E. et al. Impact of QRS duration of frequent premature ventricular complexes on the development of cardiomyopathy. Heart Rhythm. 2012; 9: 1460-1464 Abstract Full Text Full Text PDF PubMed Scopus (112) Google Scholar , 6 Deyell M.W. Park K.-M. Han Y. et al. Predictors of recovery of left ventricular dysfunction after ablation of frequent ventricular premature depolarizations. Heart Rhythm. 2012; 9: 1465-1472 Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar Third, LV recovery may not be a straightforward reverse of the process producing PVC-induced CM. 6 Deyell M.W. Park K.-M. Han Y. et al. Predictors of recovery of left ventricular dysfunction after ablation of frequent ventricular premature depolarizations. Heart Rhythm. 2012; 9: 1465-1472 Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar Thus, there may be other pathophysiological influences unique to the recovery process. Regardless of these uncertainties, when confronted with a patient with frequent PVCs and low LV ejection fraction (LVEF) of unknown reason, the primary goal remains to suppress PVCs and determine the extent of LVEF recovery. Catheter ablation is the preferred therapy, as most PVCs are accessible by percutaneous approach, with high acute success rates and low adverse incident rates. 3 Yarlagadda R.K. Iwai S. Stein K.M. Markowitz S.M. Shah B.K. Cheung J.W. Tan V. Lerman B.B. Mittal S. Reversal of cardiomyopathy in patients with repetitive monomorphic ventricular ectopy originating from the right ventricular outflow tract. Circulation. 2005; 112: 1092-1097 Crossref PubMed Scopus (321) Google Scholar However, as catheter ablation of PVCs becomes more commonplace, it is important to distinguish, up front, patients with no recovery (CM with superimposed PVCs) or have suboptimal recovery of LV function (PVC-worsened CM) from those with complete LV recovery (pure PVC-induced CM or so-called pure honey). Such information will improve patient selection and guide counseling regarding both procedural outcome and overall prognosis. Clinical recognition of pure premature ventricular complex-induced cardiomyopathy at presentationHeart RhythmVol. 14Issue 12PreviewFrequent premature ventricular complexes (PVCs) can induce or worsen left ventricular (LV) systolic dysfunction. Full-Text PDF