Role of Exercise Stress Test in Evaluating Athletes with Premature Ventricular Beats: A Retrospective Study

Background: In athletes, managing ventricular arrhythmias/premature ventricular contractions (VA/PVCs) is challenging, mainly because their detection, in some cases, even when initial diagnostic tests such as first-line studies and echocardiography do not reveal underlying cardiac pathology, indicates an increased risk of Sudden Cardiac Death.It remains unclear whether PVBs are more prevalent in athletes than less active individuals.Identifying the localization of VA/PVCs based on their morphology and assessing the impact of adrenergic stimulation on them is crucial for risk stratification and guiding further diagnostic studies.Objectives: This study was designed to compare the prevalence and morphology of VA/PVCs recorded during resting and stress ECG in a cohort of apparently healthy young competitive athletes.It also aimed to determine the potential of exercise testing to increase the detection of PVBs in clinically asymptomatic arrhythmogenic heart disease, owing to its ability to induce adrenergic-dependent PVBs.Methods: The retrospective cross-sectional study included 855 nonelite, competitive athletes (mean age 19±5.2 years, male/female ratio 746/109=6.8)who underwent Pre-Participation Evaluation at the Clinical Center for Sports Medicine and Rehabilitation of TSMU.Initially, athletes with at least one PVB on Resting and/or Exercise ECG were identified.Athletes with a positive Family History (FH) or/and Medical History (MH), Resting/Stress ECG abnormalities were excluded from our study.VA/PVCs were evaluated in terms of number, complexity, exercise inducibility, and morphologic features.Results: According to our study, the prevalence of VA/PVCs in athletes with a normal MH/FH, baseline ECG and ECHO is 10.17% (0.1; 102:1000; annual 20.4:1000).VA/PVCs with infundibular and fascicular morphology is more common than "uncommon" ones (64% versus 36%), with fascicular morphology being more prevalent in our cohort than infundibular (35.6% versus 28.7%).According to our study data, the sensitivity of resting ECG to detect VA/PVCs compared to exercise test does not exceed 13.8 %, and its negative predictive value is low at 0.9.The effectiveness of exercise testing in detecting VA/PVCS increases by five times.Conclusions: The prevalence of PVB/VA among young athletes without structural heart disease is low and similar to that among non-athletes, suggesting that VA/PVCs cannot be solely attributed to regular physical exercise.The rarest PVB is "wide" RBBB, so comprehensive evaluation is necessary when detecting it in athletes.Compared to resting ECG, exercise testing increases the screening potential for detecting VA/PVCs.Adrenergic stimulation suppresses "common" morphology extrasystoles more than "uncommon" ones.Therefore, we can use ETT to assess the risk in athletes and assign further diagnostic tests.