Provocative Cases -> Teaching Case Reports D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-119 - An Unusual And Reversible Cause Of Premature Ventricular Contractions : Looking Above The Heart (ID 924)

 M. Subramanian: Nothing relevant to disclose.


Background: Although catheter ablation of premature ventricular contractions(PVCs) has a high success rate, it is important to identify medically reversible causes of PVCs during patient evaluation.
Objective: We report a case of acromegaly, in whom there was complete normalization of left ventricular ejection fraction(LVEF) and PVC burden following surgery of the pituitary adenoma.
Results: A 57 year old male with frequent palpitations had been referred for catheter ablation in view of PVCs and documented ventricular tachycardia. He had macroglossia, and swelling of the soft tissues of the hands and legs. ECG revealed frequent monomorphic PVCs with outflow tract morphology. He had concentric left ventricular hypertrophy with an LVEF of 42%. The hollter showed a PVC burden of 53% with runs of non-sustained ventricular tachycardia. Cardiac MRI and 18FDG PET-CT did not show late gadolinium enhancement or myocardial uptake, respectively. He had normal epicardial coronary arteries. A cerebral MRI confirmed the presence of a pituitary adenoma. His baseline growth hormone(GH) and insulin like growth factor- 1(IGF- 1) levels were 11.2 ng/ml(normal range : 0.03-2.47 ng/ml) and 622.2 ng/ml(normal range: 81-238 ng/ml), respectively. He underwent trans-sphenoidal surgical resection of the pituitary adenoma. The serial changes in IGF-1, PVC burden, and LVEF over 12 months after surgery are shown in the figure. He had complete normalization of LVEF and PVC burden at 1 year of follow up.
Conclusion: Acromegaly is a completely reversible cause of premature ventricular contractions and cardiomyopathy. High clinical suspicion is required for early diagnosis and management.