The prevalence and clinical significance of premature ventricular beats in the athlete

Adolescents and adults with cardiovascular disease who are engaged in sports activity have an increased risk of sudden cardiac death (SCD) that is three times greater than that of their non-athletic counterparts. Sport acts as a trigger for cardiac arrest in the presence of underlying cardiovascular diseases predisposing to life-threatening ventricular arrhythmias. Frequent and complex premature ventricular beats (PVBs) detected during the cardiovascular screening of the athletic population may be a sign of an underlying cardiovascular disease at risk of SCD, but are also often recorded in trained athletes without cardiovascular abnormalities. Thus, the interpretation of PVBs could represent a clinical dilemma, particularly in the athlete. However, while some characteristics of PVBs can be considered common and benign, others occur uncommonly in the athletic population and raise the suspicion of an underlying cardiovascular disease. This review discusses the prevalence and clinical significance of PVBs in the athlete, with a focus on exercise-induced PVBs, on the analysis of PVB's morphology at 12-lead ECG, and on the morphological substrates identified by imaging techniques. The implications on eligibility for competitive sports participation are also discussed, according to the relevance of PVB detection for disqualifying athletes from competitions.