Improvement in Exercise Tolerance after Catheter Ablation for Premature Ventricular Complexes: A Case Report

BACKGROUND: Recent reports on catheter ablation for premature ventricular complex (PVC) or ventricular tachycardia in the context of cardiomyopathy suggest that ablation can improve cardiac function and decrease the number of PVCs. However, reports on exercise tolerance after catheter ablation for PVC are few. CASE: A 56-year-old woman consulted her primary care doctor presenting with palpitations and fatigue on exertion. Her left ventricular systolic function had been normalized with medications after a diagnosis of dilated cardiomyopathy 5 years previously. Electrocardiography showed sinus rhythm and ventricular bigeminy. Holter electrocardiography revealed a total of 34,867 PVCs. The highest number of consecutive PVCs recorded was three. In the cardiopulmonary exercise test, the peak oxygen consumption (VO(2)) was markedly reduced to 14 ml/kg/min. The patient was referred to our hospital for catheter ablation because pharmacotherapy was ineffective. PVCs originated from the left ventricular outflow tract and were successfully eliminated by ablation at the non-coronary cusp of the aortic valve using three-dimensional activation mapping with a CARTO system. The patient’s symptoms on exertion improved immediately after ablation. Postoperative Holter electrocardiography revealed that the number of PVCs had decreased to one per day. Peak VO(2) had markedly improved to 22 ml/kg/min 2 months after catheter ablation therapy. DISCUSSION: The elimination of frequent PVCs contributed to improved exercise tolerance.