Key result
PVC runs of ≥3 beats predict nonremission in pediatric outflow tract ventricular arrhythmias.
Why the study?
Pediatric outflow tract ventricular arrhythmia frequently resolves on its own, and while potential for spontaneous remission should guide clinical management, its predictors remained unclear.
Does a maximum run length of premature ventricular complexes ≥3 consecutive beats predict spontaneous remission in pediatric patients with outflow tract ventricular arrhythmia?
Cohort (n=47)
No
Does a maximum run length of premature ventricular complexes ≥3 consecutive beats predict spontaneous remission in pediatric patients with outflow tract ventricular arrhythmia?
In pediatric outflow tract ventricular arrhythmia, a maximum PVC run length of ≥3 consecutive beats strongly predicts a lower likelihood of spontaneous remission, identifying patients who may benefit from earlier intervention.
Answers are grounded in this paper and cite their sources.
May identify higher-risk pediatric OTVA for monitoring; leaves open prospective validation before guiding practice.
Background and Aims: Pediatric outflow tract ventricular arrhythmia (OTVA) generally follows a favorable clinical course with frequent spontaneous remission. Treatment is indicated with symptoms or when premature ventricular complex (PVC)-induced cardiomyopathy is present. In Japan, OTVA is often detected at an early, minimally symptomatic stage through school-based cardiac screening. Although spontaneous remission should be considered in management, its predictors remain unclear. Materials and Methods and Results: We retrospectively reviewed medical records of patients aged 5–15 years diagnosed with OTVA at a single institution between 2000 and 2024. Clinical characteristics, 12-lead and Holter electrocardiography (ECG) findings, and outcomes focusing on spontaneous remission were analyzed. Inclusion required a 24-h Holter ECG showing a PVC burden >1% of total beats. Spontaneous remission was defined as a PVC burden ≤0.1% on Holter, absence of PVCs on treadmill testing, or on repeated resting ECGs. Patients were categorized into remission and nonremission groups. A total of 47 patients (median age 12.3 years; 49% male) were included. During a median follow-up of 35.6 months (0.5–133.6), spontaneous remission occurred in 15 patients (31.9%). The maximum run length of PVCs was longer in the nonremission group than in the remission group (median: 5 [1–590] vs. 2 [1–24] beats). Receiver operating characteristic analysis identified ≥3 consecutive beats as the optimal cutoff for predicting nonremission (area under the curve 0.746; sensitivity: 81.6%, specificity: 66.7%). Kaplan–Meier analysis showed a significantly lower remission rate in patients with ≥3 beats ( P < 0.001). The median time to remission was 35 months in the nonventricular tachycardia (VT) group versus 135 months in the VT group. Conclusions: The maximum run length is a useful predictor of spontaneous remission in pediatric OTVA. Patients with PVC runs of ≥3 consecutive beats are unlikely to remit spontaneously and may require earlier therapeutic intervention, even when mildly symptomatic.
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Watanabe et al. (2026) conducted a cohort in Pediatric outflow tract ventricular arrhythmia (OTVA) (n=47). Maximum PVC run length ≥3 consecutive beats vs. Maximum PVC run length <3 consecutive beats was evaluated on Spontaneous remission of outflow tract ventricular arrhythmia (PVC burden ≤0.1% on Holter, or absence of PVCs on treadmill testing or repeated resting ECGs) (AUC 0.746, p=<0.001). A maximum PVC run length of ≥3 consecutive beats predicted nonremission of pediatric OTVA with lower remission rates.
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