Frequent Ventricular Premature Beats in Children and Adolescents: Natural History and Relationship with Sport Activity in a Long-Term Follow-Up

  • Giulio PorceddaEmail author
  • Alice Brambilla
  • Silvia Favilli
  • Gaia Spaziani
  • Giuseppe Mascia
  • Marzia Giaccardi
Original Article


Premature ventricular complexes (PVCs) are frequently documented in children. To date, few studies report long-term follow-up in pediatric cohorts presenting with frequent PVCs. The aim of this study is to assess the clinical relevance and long-term outcomes of frequent PVCs (≥ 500/24 h) in a large pediatric cohort. From 1996 to 2016, we enrolled all consecutive patients evaluated at Anna Meyer Children Hospital for frequent PVCs. Symptomatic children were excluded together with those patients with known underlying heart diseases; thus, our final cohort of study included 103 patients (male 66%; mean age 11 ± 3.4 years), with a mean follow-up of 9.5 ± 5.5 years. All patients were submitted to complete non-invasive cardiologic evaluation. The mean number of PVCs at Holter Monitoring (HM) was 11,479 ± 13,147/24 h; couplets and/or triplets were observed in 5/103 (4.8%) cases; 3 patients (2.9%) presented runs of non-sustained ventricular tachycardia (NSVT). High-burden PVCs (> 30,000/24 h) was confirmed in 11/103 (10.6%) patients. During the follow-up, only five patients (4.8%) developed clinical symptoms (3 for palpitations, 1 myocardial dysfunction due to frequent PVCs and NTSV; 1 arrhythmogenic cardiomyopathy); no deaths occurred. Basal PVCs were still present in 45/103 (43.7%) patients. Our data suggest that frequent PVCs may be addressed as a benign condition and should not preclude sport participation if not associated with cardiac malformations, heart dysfunction, or cardiomyopathy. This seems to be true also in presence of very frequent/high-burden PVCs. Otherwise, a careful follow-up is mandatory since sport eligibility should be reconsidered in case of onset of symptoms and/or ECG/echocardiographic changes.


Premature ventricular contractions Screening Children Ventricular tachicardia 





Premature ventricular complexes




Doppler echocardiography


Effort test/stress test


Holter monitoring


Magnetic resonance imaging


Electrophysiologic study


Right ventricle


Right ventricular outflow tract


Right bundle branch block


Left bundle branch block


Non-sustained ventricular tachycardia


Ventricular arrhythmias


Left ventricle


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The research involves human participants and informed consent forms have been collected from all patients or their parents. The present study was conducted according with the 1964 Helsinki declaration and its later amendments.


  1. 1.
    Attina DA, Mori F, Falorni PL, Musante R, Cupelli V (1987) Long-term follow-up in children without heart disease with ventricular premature beats. Eur Heart J 8 Suppl D:21–23PubMedCrossRefGoogle Scholar
  2. 2.
    Tsuji A, Nagashima M, Hasegawa S et al (1995) Long-term follow-up of idiopathic ventricular arrhythmias in otherwise normal children. Jpn Circ J 59:654–662PubMedCrossRefGoogle Scholar
  3. 3.
    Davis AM, Gow RM, McCrindle BW et al (1996) Clinical spectrum, therapeutic management, and follow-up of ventricular tachycardia in infants and young children. Am Heart J 131:186–191PubMedCrossRefGoogle Scholar
  4. 4.
    Pfammatter JP, Paul T (1999) Idiopathic ventricular tachycardia in infancy and childhood. J Am Coll Cardiol 33:2067–2072PubMedCrossRefGoogle Scholar
  5. 5.
    Crosson JE, Callans DJ, Bradley DJ et al (2014) PACES/HRS expert consensus statement on the evaluation and management of ventriculararrhythmias in the child with a structurally normal heart. Heart Rhythm 11(9):e55–78PubMedCrossRefGoogle Scholar
  6. 6.
    West L, Beerman L, Arora G et al (2015) Ventricular ectopy in children without known heart disease. J Pediatr 166(2):338–342PubMedCrossRefGoogle Scholar
  7. 7.
    Drago F, Leoni L, Bronzetti G et al (2017) Premature ventricular complexes in children with structurally normal hearts: clinical review and recommendations for diagnosis and treatment. Minerva Pediatr 69:427–433PubMedGoogle Scholar
  8. 8.
    Neuspiel DR, Kuller LH (1985) Sudden and unexpected natural death in childhood and adolescence. JAMA 254:1321–1325PubMedCrossRefGoogle Scholar
  9. 9.
    Driscoll DJ, Edwards WD et al (1985) Sudden unexpected death in children and adolescents. JACC 5[6Suppl]:118B–121BGoogle Scholar
  10. 10.
    Maron BJ, Shirani J, Poliac LC et al (1996) Sudden death in young competitive athletes: clinical, demographic and pathological profiles. JAMA 276:199–204PubMedCrossRefGoogle Scholar
  11. 11.
    Maron BJ, Gohman TE, Aeppli D (1998) Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes. JACC 32:1881–1884PubMedCrossRefGoogle Scholar
  12. 12.
    Wren C, O’Sullivan JJ, Wright C (2000) Sudden death in children and adolescents. Heart 83:410–413PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Biffi A, Pelliccia A, Verdile L et al (2002) Longterm clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes. J Am Coll Cardiol 40:446–452PubMedCrossRefGoogle Scholar
  14. 14.
    Kennedy HL (2002) Ventricular ectopy in athletes. Don’t worry….more good news. JACC 40:453–456PubMedCrossRefGoogle Scholar
  15. 15.
    Corrado D, Basso C, Thiene G (2005) Essay sudden death in young athletes. Lancet 366:S47–S48PubMedCrossRefGoogle Scholar
  16. 16.
    Mont L, Pelliccia A, Sharma S et al (2017) Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Eur J Prev Cardiol 24(1):41–69.PubMedCrossRefGoogle Scholar
  17. 17.
    Sahn DJ, De Maria A, Kisslo J et al (1978) Recommendations regarding quantification in M-mode echocardiography: results of a survey of echocardiograph measurements. Circulation 58:1071–1083Google Scholar
  18. 18.
    Henry WL, De Maria A, Gramiak R et al (1980) Report of the American Society of Echocardiography. Commettee on nomenclature and standards in two-dimensional echocardiography. Circulation 62:212–217PubMedCrossRefGoogle Scholar
  19. 19.
    Donner DG, Kiriazis H, Du XJ et al (2018) Improving the quality of preclinical research echocardiography: observations, training, and guidelines for measurement. Am J Physiol Heart Circ Physiol 315(1):H58–H70PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Lie OH, Saberniak J, Dejgaard LA et al (2017) Lower than expected burden of premature ventricular contractions impairs myocardial function. ESC Heart Fail 4(4):585–594PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Muser D, Santangeli P, Selvanayagam JB et al (2019) Role of cardiac magnetic resonance imaging in patients with idiopathic ventricular arrhythmias. Curr Cardiol Rev 15(1):12–23PubMedCrossRefGoogle Scholar
  22. 22.
    Giaccardi M, Colella A, Favilli S, Zuppiroli A, Gensini GF (2010) Disfunzione sistolica severa da extrasistolia ventricolare in un paziente già sottoposto ad ablazione di via accessoria. G Ital Cardiol 11:856–859Google Scholar
  23. 23.
    Brodsky M, Wu D, Denes P et al (1977) Arrhythmias documented by 24 hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease. Am J Cardiol 39:390–395PubMedCrossRefGoogle Scholar
  24. 24.
    Southall DP, Richards J, Mitchell P et al (1980) Study of cardiac rhythm in healthy newborn infants. Br Heart J 43:14–20PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Scott O, Williams CJ, Fiddler GI (1980) Results of 24 hour ambulatory monitoring of electrocardiogram in 131 healthy boys aged 10 to 13 years. Br Heart J 44:304–308PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Sobotka PA, Mayer JH, Bauernfeind RA et al (1981) Arrhythmias documented by 24-hour continuous ambulatory electrocardiographic monitoring in young women without apparent heart disease. Am Heart J 101:753–759PubMedCrossRefGoogle Scholar
  27. 27.
    Dickinson DF, Scott O (1984) Ambulatory electrocardiographic monitoring in 100 healthy teenage boys. Br Heart J 51:179–183PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Nagashima M, Matsushima M, Ogawa A et al (1987) Cardiac arrhythmias in healthy children revealed by 24-hour ambulatory ECG monitoring. Pediatr Cardiol 8:103–108PubMedCrossRefGoogle Scholar
  29. 29.
    Czosek RJ, Jefferies JL, Khoury PR et al (2016) Arrhythmic burden and ambulatory monitoring of pediatric patients with cardiomyopathy. Pacing Clin Electrophysiol 39:443–451PubMedCrossRefGoogle Scholar
  30. 30.
    Jiang J, He Y, Qiu H, Zhang Y et al (2017) Analysis of morphological characteristics and origins of idiopathic premature ventricular contractions under a 12-lead electrocardiogram in children with structurally normal hearts. Int Heart J 58(5):714–719PubMedCrossRefGoogle Scholar
  31. 31.
    Abadir S, Blanchet C, Fournier A et al (2016) Characteristics of premature ventricular contractions in healthy children and their impact on left ventricular function. Heart Rhythm 13(11):2144–2148PubMedCrossRefGoogle Scholar
  32. 32.
    Chantepie A, Soulé N, Poinsot J et al (2016) Cardiomyopathy induced by frequent premature ventricular contractions. Arch Pediatr 23(7):742–746PubMedCrossRefGoogle Scholar
  33. 33.
    Barold HS, Hesselson AB, Jollis J, Wharton JM, Bahnson TD (1998) Concealed mechanical bradycardia: an indication for permanent pacemaker implantation. Pacing Clin Electrophysiol 21:2007–2008PubMedCrossRefGoogle Scholar
  34. 34.
    Tada H, Ito S, Shinbo G et al (2006) Significance and utility of plasma brain natriuretic peptide concentrations in patients with idiopathic ventricular arrhythmias. Pacing Clin Electrophysiol 29:1395–1403PubMedCrossRefGoogle Scholar
  35. 35.
    Bertels RA, Harteveld LM, Filippini LH et al (2017) Left ventricular dysfunction is associated with frequent premature ventricular complexes and asymptomatic ventricular tachycardia in children. Europace 19:617–621PubMedGoogle Scholar
  36. 36.
    Latchamsetty R, Bogun F (2019) Premature ventricular complex-induced cardiomyopathy. JACC Clin Electrophysiol 5(5):537–550PubMedCrossRefGoogle Scholar
  37. 37.
    Sharma S, Whyte G, Elliot P et al (1999) Electrocardiographic changes in 1000 highly trained junior elite athletes. Br J Sports Med 33:319–324PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Iellamo F, Legramante JM, Pigozzi F et al (2002) Conversion from vagal to sympathetic predominance with strenuous training in high-performance world class athletes. Circulation 105:2719–2724PubMedCrossRefGoogle Scholar
  39. 39.
    Heidbuchel H, Hoogsteen J, Fagard R et al (2003) High prevalence of right ventricular involvement in endurance athletes with ventricular arrhythmias. Eur Heart J 24:1473–1480PubMedCrossRefGoogle Scholar
  40. 40.
    Biffi A, Maron BJ, Verdile L et al (2004) Impact of physical deconditioning on ventricular tachyarrhythmias in trained athletes. JACC 44:1053–1058PubMedCrossRefGoogle Scholar
  41. 41.
    Delise P, Guiducci U, Zeppilli P et al (2017) Protocolli cardiologici per il giudizio di idoneità allo sport agonistico. Ital Heart J Suppl 6(8):502–546Google Scholar
  42. 42.
    Parisi A, Tranchita E, Minganti C et al (2018) Young athletes with ventricular premature beats. Continuing or not intense training and competition? Scand J Med Sci Sports 28:541–548PubMedCrossRefGoogle Scholar
  43. 43.
    Carlson MD, White RD, Trohman RG et al (1994) Right ventricular outflow tract ventricular tachycardia: detection of previously unrecognized anatomic abnormalities using Cine Magnetic Resonance imaging. J Am Coll Cardiol 24:720–727PubMedCrossRefGoogle Scholar
  44. 44.
    Proclemer A, Basadonna PT, Slavich GA et al (1997) Cardiac magnetic resonance imaging findings in patients with right ventricular outflow tract premature contraction. Eur Heart J 18:2002–2010PubMedCrossRefGoogle Scholar
  45. 45.
    Pennel D, Casolo G (1997) Right ventricular arrhythmia: emergence of magnetic resonance imaging as an investigative tool. Eur Heart J 18:1843–1852CrossRefGoogle Scholar
  46. 46.
    Oebel S, Dinov B, Arya A et al (2017) ECG morphology of premature ventricular contractions predicts the presence of myocardial fibrotic substrate on cardiac magnetic resonance imaging in patients undergoing ablation. J Cardiovasc Electrophysiol 28(11):1316–1323PubMedCrossRefGoogle Scholar
  47. 47.
    Yokokawa M, Siontis KC, Kim HM et al (2017) Value of cardiac magnetic resonance imaging and programmed ventricular stimulation in patients with frequent premature ventricular complexes undergoing radiofrequency ablation. Heart Rhythm 14(11):1695–1701PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Giulio Porcedda
    • 1
    Email author
  • Alice Brambilla
    • 1
  • Silvia Favilli
    • 1
  • Gaia Spaziani
    • 1
  • Giuseppe Mascia
    • 2
  • Marzia Giaccardi
    • 2
  1. 1.Pediatric Cardiology UnitA. Meyer HospitalFlorenceItaly
  2. 2.Cardiology and Electrophysiology UnitS. M. Nuova HospitalFlorenceItaly

Personalised recommendations