Case Report: Idiopathic Premature Ventricular Complex Occurring During Long Intermittent Fasting

Ventricular arrhythmia was found to be linked to long intermittent fasting in a case report published in the Journal of Electrocardiology.

Premature ventricular complex (PVC) has been associated with conditions that include ischemia, cardiomyopathy, and electrolyte abnormalities and may also occur in the absence of structural heart disease. Idiopathic PVCs are considered to be benign arrhythmias, they are also associated with an increased mortality risk. Researchers presented the first case report of ventricular arrhythmia induced by a period of long intermittent fasting during Ramadan.

In this case report a man, aged 31 years, without chronic diseases or medication use, presented to a clinic after identifying an abnormal pulse during palpitation of his radial artery. At the time of presentation, the patient had been practicing intermittent fasting for Ramadan for approximately 18 hours.

PVCs originating from the patient’s right ventricular outflow tract in a pattern of bigeminy and incomplete right bundle branch blocks were detected on an electrogram. Cardiac magnetic resonance imaging showed normal cardiac functions without organic disease, and the right ventricular structure and functions were normal. A 24-hour rhythm monitoring indicated normal basal sinus rhythm with incomplete right bundle branch block and 17,325 monomorphic PVCs (22% of beats), 10,691 of which had a bigeminy pattern.

After fasting, the second rhythm monitoring showed 7466 PVCs. After Ramadan, the patient’s arrhythmia disappeared within 1 week, with only 558 PVCs over the course of a day. The patient was asymptomatic until the next fasting period, and no arrhythmia was detected during non-fasting periods. In the second and third years of fasting for Ramadan, arrhythmia relapsed with 13,478 PVCs and 15,435 PVCs in 1 day, respectively, and stopped with the conclusion of Ramadan. The patient had no arrhythmia between fasting periods, as indicated by 24-hour rhythm monitoring. Three years after the first arrhythmia, the patient’s cardiac function remained normal and no medication was needed.

“[I]t is possible that fasting-related ion channel changes in myocardial cells can cause arrhythmia,” concluded the report authors. “As the arrhythmia terminated spontaneously at the end of fasting period, this supports the mentioned mechanism in our patient. Although electrolyte levels were in the normal range during both fasting and non-fasting periods in our patient, determining the electrolyte values at the cellular level can confirm arrhythmia.” 

Reference

Kahraman S, Dogan A. Ventricular arrhythmia linked to long intermittent fasting [published November 14, 2019]. J Electrocardiol. doi: 10.1016/j.jelectrocard.2019.10.008