Smartwatch-enabled early detection and treatment of cardiomyopathy induced by premature atrial contractions: a case report.

Background: Arrhythmia-induced cardiomyopathy (AiCM) is an increasingly recognized cause of heart failure. Atrial fibrillation and premature ventricular contractions are common causes of AiCM. Further, the use of wearable technology in arrhythmia detection is increasing steadily. In this case, we report on a patient suffering from AiCM as a result of frequent premature atrial contractions (PACs) detected by a wearable device. Case summary: A 34-year-old male, with no prior medical history, presented after his smartwatch detected frequent 'heart arrhythmias.' An initial electrocardiogram showed sinus rhythm with frequent PACs. Further evaluation revealed left ventricular dysfunction [left ventricular ejection fraction (LVEF) 35%]. Non-invasive tests ruled out coronary artery disease. Although the patient was initially asymptomatic, his condition worsened with a decline in LVEF to 15% despite optimal medical therapy. High-resolution 3D mapping identified the ectopic focus in the left inferior pulmonary vein, and radiofrequency ablation successfully eliminated the PACs. At the six-month follow-up, the patient was symptom-free with a recovered LVEF of 50%. Discussion: This case highlights the potential for frequent PACs to induce AiCM. Although PACs are typically considered benign, in this case, the high PAC burden led to significant left ventricular dysfunction. The successful resolution of the patient's symptoms and the improvement in heart function after radiofrequency ablation demonstrate the reversibility of AiCM caused by PACs if treated early. Importantly, this case underscores the emerging role of wearable technologies, like smartwatches, in the early detection of arrhythmias, enabling timely intervention to prevent the progression of heart failure.