Abstract
Athletes with premature ventricular beats (PVBs) are not rare. The risk of malignant ventricular arrhythmias depends on the presence of an underlying pathological myocardial substrate. The standard diagnostic workup includes family and personal history, resting ECG, 24-h ambulatory ECG (possibly with 12-lead and including a training session), maximal exercise testing, and echocardiography. However, normal first-line investigation does not definitely rule out the presence of a concealed substrate (such as ventricular scars) that can be revealed only by more in-depth investigations (particularly cardiac magnetic resonance). Features that can help estimating the probability that the PVBs are linked to a heart disease and that suggest the need for second-level testing include morphology, complexity, and inducibility by exercise.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Corrado D, Basso C, Rizzoli G, Schiavon M, Thiene G. Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol. 2003;42(11):1959–63.
Gaita F, Giustetto C, Di Donna P, Richiardi E, Libero L, Brusin MC, Molinari G, Trevi G. Long-term follow-up of right ventricular monomorphic extrasystoles. J Am Coll Cardiol. 2001;38(2):364–70.
D’Ascenzi F, Zorzi A, Alvino F, Bonifazi M, Mondillo S, Corrado D. L’extrasistolia ventricolare nel giovane atleta: inquadramento e percorso diagnostico. G Ital Cardiol. 2019;20(4):229–41.
Corrado D, Drezner JA, D’Ascenzi F, Zorzi A. How to evaluate premature ventricular beats in the athlete: critical review and proposal of a diagnostic algorithm. Br J Sports Med. 2020;54:1142–8.
Corrado D, Pelliccia A, Heidbuchel H, Sharma S, Link M, Basso C, et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J. 2010;31(2):243–59.
Drezner JA, Sharma S, Baggish A, Papadakis M, Wilson MG, Prutkin JM, La Gerche A, Ackerman MJ, Borjesson M, Salerno JC, Asif IM, Owens DS, Chung EH, Emery MS, Froelicher VF, Heidbuchel H, Adamuz C, Asplund CA, Cohen G, et al. International criteria for electrocardiographic interpretation in athletes: consensus statement. Br J Sports Med. 2017;51:704–31.
Niwano S, Wakisaka Y, Niwano H, Fukaya H, Kurokawa S, Kiryu M, Hatakeyama Y, Izumi T. Prognostic significance of frequent premature ventricular contractions originating from the ventricular outflow tract in patients with normal left ventricular function. Heart. 2009;95(15):1230–7.
Buxton AE, Marchlinski FE, Doherty JU, Cassidy DM, Vassallo JA, Flores BT, Josephson ME. Repetitive, monomorphic ventricular tachycardia: clinical and electrophysiologic characteristics in patients with and patients without organic heart disease. Am J Cardiol. 1984;54(8):997–1002.
Morshedi-Meibodi A, Evans JC, Levy D, Larson MG, Vasan RS. Clinical correlates and prognostic significance of exercise-induced ventricular premature beats in the community: the Framingham heart study. Circulation. 2004;109:2417–22.
Verdile L, Maron BJ, Pelliccia A, Spataro A, Santini M, Biffi A. Clinical significance of exercise-induced ventricular tachyarrhythmias in trained athletes without cardiovascular abnormalities. Heart Rhythm. 2015;12(1):78–85.
Steriotis AK, Nava A, Rigato I, et al. Noninvasive cardiac screening in young athletes with ventricular arrhythmias. Am J Cardiol. 2013;111(4):557–62.
Rahilly GT, Prystowsky EN, Zipes DP, Naccarelli GV, Jackman WM, Heger JJ. Clinical and electrophysiologic findings in patients with repetitive monomorphic ventricular tachycardia and otherwise normal electrocardiogram. Am J Cardiol. 1982;50(3):459–68.
Zorzi A, De Lazzari M, Mastella G, Niero A, Trovato D, Cipriani A, Peruzza F, Portolan L, Berton G, Sciacca F, Tollot S, Palermo C, Bellu R, D’ascenzi F, Muraru D, Badano LP, Iliceto S, Schiavon M, Marra MP, Corrado D. Ventricular arrhythmias in young competitive athletes: prevalence, determinants, and underlying substrate. J Am Heart Assoc. 2018;7(12):e009171.
Zorzi A, Marra MP, Rigato I, De Lazzari M, Susana A, Niero A, Pilichou K, Migliore F, Rizzo S, Giorgi B, De Conti G, Sarto P, Serratosa L, Patrizi G, De Maria E, Pelliccia A, Basso C, Schiavon M, Bauce B, et al. Nonischemic left ventricular scar as a substrate of life-threatening ventricular arrhythmias and sudden cardiac death in competitive athletes. Circ Arrhythm Electrophysiol. 2016;9(7):e004229.
Nucifora G, Muser D, Masci PG, Barison A, Rebellato L, Piccoli G, Daleffe E, Toniolo M, Zanuttini D, Facchin D, Lombardi M, Proclemer A. Prevalence and prognostic value of concealed structural abnormalities in patients with apparently idiopathic ventricular arrhythmias of left versus right ventricular origin: a magnetic resonance imaging study. Circ Arrhythm Electrophysiol. 2014;7(3):456–62.
Schnell F, Claessen G, La Gerche A, Bogaert J, Lentz PA, Claus P, Mabo P, Carre F, Heidbuchel H. Subepicardial delayed gadolinium enhancement in asymptomatic athletes: let sleeping dogs lie? Br J Sports Med. 2016;50(2):111–7.
Priori SG, Napolitano C, Memmi M, Colombi B, Drago F, Gasparini M, et al. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation. 2002;106(1):69–74.
Di Gioia CRT, Giordano C, Cerbelli B, Pisano A, Perli E, De Dominicis E, Poscolieri B, Palmieri V, Ciallella C, Zeppilli P, d’Amati G. Nonischemic left ventricular scar and cardiac sudden death in the young. Hum Pathol. 2016;58:78–89.
D’Amati G, De Caterina R, Basso C. Sudden cardiac death in an Italian competitive athlete: pre-participation screening and cardiovascular emergency care are both essential. Int J Cardiol. 2016;206:84–6.
Cipriani A, Zorzi A, Sarto P, Donini M, Rigati I, Bariani R, De Lazzari M, Pilichou K, Thiene G, Iliceto S, Basso C, Corrado D, Perazzolo Marra M, Bauce B. Predictive value of exercise testing in athletes with ventricular ectopy evaluated by cardiac magnetic resonance. Heart Rhythm. 2018;16(2):239–48.
Zorzi A, Vessella T, De Lazzari M, Cipriani A, Menegon V, Sarto G, Spagnol R, Merlo L, Pegoraro C, Perazzolo Marra M, Corrado D, Sarto P. Screening young athletes for diseases at risk of sudden cardiac death: role of stress testing for ventricular arrhythmias. Eur J Prev Cardiol. 2020;27(3):311–20.
Crescenzi C, Zorzi A, Vessella T, Martino A, Panattoni F, Cipriani A, De Lazzari M, Perazzolo Marra M, Fusco A, Sciarra L, Sperandii F, Guerra E, Tranchita E, Fossati C, Pigozzi F, Sarto P, Calò L, Corrado D. Predictors of left ventricular scar using cardiac magnetic resonance in athletes with apparently idiopathic ventricular arrhythmias. J Am Heart Assoc. 2021;10(1):e018206.
Muser D, Santangeli P, Castro SA, Casado Arroyo R, Maeda S, Benhayon DA, Liuba I, Liang JJ, Sadek MM, Chahal A, Magnani S, Pieroni M, Santarossa E, Desjardins B, Dixit S, Garcia FC, Callans DJ, Frankel DS, Alavi A, Marchlinski FE, Selvanayagam JB, Nucifora G. Risk stratification of patients with apparently idiopathic premature ventricular contractions. A multicenter international CMR registry. JACC Clin Electrophysiol. 2020;6(6):722–35.
Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, et al. International recommendations for electrocardiographic interpretation in athletes. Eur Heart J. 2018;39(16):1466–80.
Zorzi A, Calore C, Vio R, Pelliccia A, Corrado D. Accuracy of the ECG for differential diagnosis between hypertrophic cardiomyopathy and athlete’s heart: comparison between the European Society of Cardiology (2010) and International (2017) criteria. Br J Sports Med. 2018;52(10):667–73.
Zeppilli P, Dello Russo A, Santini C, Palmieri V, Natale L, Giordano A, et al. In vivo detection of coronary artery anomalies in asymptomatic athletes by echocardiographic screening. Chest. 1998;114(1):89–93.
Pelliccia A, Spataro A, Maron BJ. Prospective echocardiographic screening for coronary artery anomalies in 1,360 elite competitive athletes. Am J Cardiol. 1993;72(12):978–9.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Vio, R., Corrado, D., Zorzi, A. (2022). Interpretation and Diagnostic Workup of Premature Ventricular Beats. In: Delise, P., Zeppilli, P. (eds) Sport-related sudden cardiac death. Springer, Cham. https://doi.org/10.1007/978-3-030-80447-3_8
Download citation
DOI: https://doi.org/10.1007/978-3-030-80447-3_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-80446-6
Online ISBN: 978-3-030-80447-3
eBook Packages: MedicineMedicine (R0)