Frequent premature ventricular beats in healthy children

Abstract

Purpose of reviewPremature ventricular beats (PVCs) are frequently identified in healthy children with structurally normal hearts and generally have a benign clinical course often disappearing spontaneously. However, a small percentage of children may develop a cardiomyopathy. The purpose of this review is to understand which children may be at risk of development of left ventricular (LV) dysfunction with idiopathic PVCs. Recent findingsThere is increasing evidence that a ventricular ectopic burden more than 24% in adults may lead to LV dysfunction. Most of the pediatric studies to date are retrospective, small case series from single institutions and have conflicting results regarding a direct correlation of the PVC burden to LV dysfunction. Development of a cardiomyopathy from frequent PVCs in children is likely multifactorial relating to the burden itself, presence of higher levels of ectopy (couplets and runs of ventricular tachycardia) as well as the duration of ventricular ectopy. Understanding the duration of ectopy is often unknown as patients are asymptomatic and the irregular heart beat was identified at a well-child examination. SummaryAsymptomatic children with normal ventricular function and a low ectopy burden can be followed without any intervention and generally reassured. Children with an ectopy burden more than 30% are at some risk of developing LV dysfunction and should be more closely followed with noninvasive imaging. Development of symptoms attributed to the ectopy or signs of increasing LV dimensions or LV dysfunction should be treated with medication or catheter ablation.

The Efficacy of Anti-Arrhythmic Drugs in Children With Idiopathic Frequent Symptomatic or Asymptomatic Premature Ventricular Complexes With or Without Asymptomatic Ventricular Tachycardia: a Retrospective Multi-Center Study

“…Symptomatic or asymptomatic patients with a PVC burden of 5% [ 16 ] or more on 24-h Holter recording, with or without asymptomatic VT, and evaluated by consecutive Holter recordings were included. The decision to start AAD and the choice of AAD in the five different hospitals was based on institutional or physicians preference.…”

Implementation of a practice plan for the outpatient cardiac evaluation of children after acute SARS-CoV-2 infection and a report of outcomes

“…Typically, frequent premature ventricular contractions are benign and do not require treatment, although monitoring is recommended. 8 Unfortunately in this instance cMRI was unable to be attained to determine whether this was a manifestation of myocarditis, although the normal echocardiogram and dissipation of ectopy at high heart rate on Holter were reassuring. Nevertheless, the patient will be monitored as able.…”

Evaluation of Pediatric Bradycardia: A Single Center Experience

“…Children with an ectopy burden more than 30% are at some risk of developing LV dysfunction and should be more closely followed with noninvasive imaging. Development of symptoms attributed to the ectopy or signs of increasing LV dimensions or LV dysfunction should be treated with medication or catheter ablation (19) .…”