Enterprise AI Analysis

Accurate diagnosis relies on prolonged rhythm monitoring (Holter, ILR) to quantify PVC burden, as day-to-day variability is common. Echocardiography (TTE) provides real-time functional assessment, with LVEF ideally measured on sinus beats. Subtle abnormalities like reduced global longitudinal strain predict PVC-CMP development. Cardiac magnetic resonance (CMR) is the gold standard for tissue characterization, identifying structural abnormalities and fibrosis (LGE). Absence of LGE predicts full functional normalization post-suppression, while LGE indicates secondary cardiomyopathy and lower recovery likelihood. Careful 12-lead ECG analysis helps localize PVC origin, refining ablation strategy.

Management balances guidelines with individualized judgment. Catheter ablation is Class I for symptomatic idiopathic RVOT or fascicular PVCs, showing high success and low complication rates. For PVC-CMP, ablation is Class I to reverse LV dysfunction when causality is likely, improving systolic function and symptoms. Pharmacologic therapy (β-blockers, CCBs, Class Ic AADs for specific origins) is a first-line option, but efficacy varies and Class Ic drugs are contraindicated in structural heart disease. Amiodarone is potent but has significant long-term toxicities. Early intervention prevents irreversible remodeling, with lifestyle adjustments also contributing.

Significant evidence gaps remain in PVC-CMP, including optimal timing for intervention and robust predictors of reversibility. Standardized diagnostic, imaging, biomarker, and genetic criteria are needed. AI and machine learning are rapidly transforming management: AI-enhanced ECG algorithms improve detection and localization; AI-supported mapping reduces procedural time. Future directions include multimodal predictive models combining imaging, genetic, and continuous monitoring data to estimate recurrence risk and reversibility. This will lead to more personalized diagnosis and proactive, mechanism-guided intervention.