Polymorphic PVBs (69% vs 37.5%, p<0.001), reproducible PVBs, and specific RBBB morphologies independently predicted underlying cardiac disease, which was identified in 32% of athletes with PVBs.
Observational (n=264)
Do specific clinical, ECG, and arrhythmic features predict underlying cardiovascular disease in competitive athletes with premature ventricular beats?
In competitive athletes with premature ventricular beats, specific clinical and ECG features such as polymorphic PVBs and RBBB morphology with specific axis and deflection characteristics strongly predict underlying structural heart disease.
Abstract Background Premature ventricular beats (PVBs) in apparently healthy athletes may reflect an underlying yet undiagnosed cardiac disease, which carries an increased risk of potentially life-threatening ventricular arrhythmias (VAs) and sudden cardiac death (SCD). A comprehensive evaluation of PVB characteristics can help identify athletes who warrant further investigations for a suspected pathological myocardial substrate. Purpose To identify clinical, ECG and arrhythmic features that associate with and predict underlying cardiovascular disease (CVD) in athletes with PVBs, improving clinical suspicion and guiding further evaluation. Methods Competitive athletes undergoing second-level evaluation for PVBs detected during pre-participation screening were enrolled. Athletes with PVBs on 24-hour ambulatory ECG and/or exercise testing and without known CVD were included. Clinical history, symptoms, family history of SCD/cardiomyopathy, and baseline 12-lead ECG were assessed. Ventricular arrhythmias were analysed for burden, complexity, morphology, exercise inducibility and reproducibility. Cardiac magnetic resonance (CMR) and genetic testing were performed when clinically indicated. Results A total of 264 athletes (79% male, median age 39 years) were evaluated, of whom 198 underwent CMR. An underlying cardiac disease was identified in 86 athletes (32%), including non-ischaemic left ventricular late gadolinium enhancement, arrhythmogenic cardiomyopathy, arrhythmic mitral valve prolapse and ion-channel disease. Baseline ECG abnormalities were more frequent in athletes with disease (45% vs 26.8%, p=0.007), as were symptoms suggestive of malignant arrhythmias (p=0.08). PVBs with multiple morphologies (69% vs 37.5%, p0.001) and reproducible PVBs (94% vs 80%, p=0.009) were more prevalent in case of CVD. Ventricular arrhythmias showing right bundle-branch block (RBBB) morphology with intermediate/superior axis were more common in athletes with disease (75.5% vs 45%, p0.001). Within this subgroup, a wide, monophasic R wave in V1 or intrinsicoid deflection 80 ms was markedly associated with disease (47.7% vs 13.4%, p0.001). In multivariable analysis, symptoms of stress-related syncope/presyncope, polymorphic PVBs, reproducible PVBs, and RBBB morphology with an intermediate/superior axis and a wide monophasic R wave in V1 or an intrinsicoid deflection 80 ms were independent predictors of a pathological substrate. Conclusions An underlying cardiac disease was found in one-third of athletes with VAs. Independent predictors included: symptoms of malignant arrhythmias, polymorphic PVBs, reproducible PVBs, and RBBB morphology with intermediate/superior axis and a wide monophasic R wave in V1 or intrinsicoid deflection 80 ms. These markers may assist in refining risk assessment and in identifying athletes who could benefit from additional investigations.
Graziano et al. (Mon,) conducted a observational in Premature ventricular beats in athletes (n=264). Clinical, ECG, and arrhythmic features vs. Absence of these features was evaluated on Underlying cardiac disease. Polymorphic PVBs (69% vs 37.5%, p<0.001), reproducible PVBs, and specific RBBB morphologies independently predicted underlying cardiac disease, which was identified in 32% of athletes with PVBs.