Role of Cardiac Magnetic Resonance Imaging in the Evaluation of Athletes with Premature Ventricular Beats

Figure 1. A 40-year-old athlete presented with frequent PVBs on ECG ambulatory monitoring. Exercise test revealed frequent and repetitive monomorphic PVBs with RBBB/inferior axis morphology ((A), red asterisks). Post-contrast sequences on CMR showed an LGE subepicardial/midmyocardial stria in the basal inferolateral and inferior LV walls (white triangles; (B) short-axis view; (C) 3-chamber view).

Figure 2. A 26-year-old competitive hockey player presented with frequent PVBs with right bundle branch block/superior axis morphology at high workload during exercise testing ((A), red asterisks). Post-contrast sequences on CMR revealed a subepicardial stria of LGE with a “ring-like” pattern, involving the anterior, lateral and inferior LV walls in their basal and medium portions (green dotted line; (B) 4-chamber view; (C) short-axis view); the presence of fibrous tissue is also confirmed by the increased signal in the correspondent areas in the native T1 mapping short-axis sequence (D).

Figure 3. CMR: cardiac magnetic resonance; EIVA: exercise-induced ventricular arrhythmias; ECG: electrocardiogram; VA: ventricular arrhythmias; RBBB: right bundle branch block. Reproduced with permission from [22].

Figure 4. Summary of the main findings of a study enrolling 286 young competitive athletes and 143 healthy sedentary controls who volunteered to undergo 12-lead 24 h ambulatory ECG monitoring. LBBB, left bundle branch block; LGE, late gadolinium enhancement; LV, left ventricular; NSVT, non-sustained ventricular tachycardia; PVB, premature ventricular beat; RBBB, right bundle branch block; VA, ventricular arrhythmia. Reproduced with permission from [73].

Figure 5. Summary of the main findings of a multicenter study on 251 athletes with ventricular arrhythmias, normal echocardiography and unremarkable ECG findings and a negative family history. Reproduced with permission from [23].

Figure 6. Summary of the main findings of a study investigating the additional value of exercise testing for ventricular arrhythmias in addition to history, physical examination and ECG in the setting of athletes’ preparticipation screening. Reproduced with permission from [24].

Figure 7. Proposed algorithm for evaluation of athletes with premature ventricular beats. * Twenty-four-hour ECG monitoring should ideally have a 12-lead configuration and include a training session. NEG, negative; POS, positive; PVBs, premature ventricular beats. Reproduced with permission from [9].