Spontaneous resolution of idiopathic ventricular arrhythmias in children: clinical predictors and a probability-based scoring system

Idiopathic ventricular arrhythmias (VAs) in children are often benign, with a known potential for spontaneous resolution. However, the ability to predict which patients will experience resolution remains challenging, leading to uncertainties in management, including the timing of intervention . This study aimed to identify independent clinical predictors of spontaneous VA resolution in children and to develop a practical scoring system for risk stratification. We conducted a retrospective single-center cohort study of 392 children (median age 13.0 [IQR 9.0–15.0] years; 56.6% male) with idiopathic VAs, confirmed after comprehensive exclusion of structural heart disease and channelopathies. Spontaneous resolution was defined as the complete absence of the baseline VA morphology on follow-up ECG and Holter monitoring. Clinical and electrocardiographic parameters were compared between patients with and without resolution. Multivariable Cox regression analysis was used to identify independent predictors, which were then incorporated into a probability-based scoring system. Over a median follow-up of 32.5 [18.0–58.5] months, spontaneous resolution occurred in 97 patients (24.7%). Multivariable analysis identified four independent predictors of resolution: age < 12 years (adjusted HR 1.88; 95% CI: 1.19–2.96; p = 0.007), isolated premature ventricular complexes (PVCs) without ventricular tachycardia (adjusted HR 3.14; 95% CI: 1.81–5.43; p < 0.001), right-sided origin of ectopy (adjusted HR 1.96; 95% CI: 1.10–3.49; p = 0.023), and a 24-h PVC burden < 20% (adjusted HR 1.76; 95% CI: 1.15–2.70; p = 0.010). A scoring system (range 0–4.5 points) based on these factors demonstrated good discriminatory ability (AUC 0.81; 95% CI: 0.76–0.86; p < 0.001) and effectively stratified patients into high-, intermediate-, and low-probability groups for spontaneous resolution. Conclusion : We identified key predictors of spontaneous resolution of idiopathic VAs in children. The proposed scoring system provides a practical tool for clinical decision-making, potentially helping to identify children who are most likely to benefit from conservative management and avoid unnecessary invasive procedures. What is Known: • Long-term follow-up demonstrates a substantial reduction or complete disappearance of idiopathic ectopy in children. • Complete resolution of ventricular arrhythmias was observed in in almost half of the cases. What is New: • Multivariable analysis identified four independent predictors of resolution of ventricular arrhythmias: - age < 12 years at the time of the onset of ventricular arrhythmia - isolated premature ventricular complexes (PVCs) without ventricular tachycardia - right-sided origin of ectopy - 24-h PVC burden < 20%