Premature ventricular beats in the athlete: management considerations

Expert Rev Cardiovasc Ther. 2018 Apr;16(4):277-286. doi: 10.1080/14779072.2018.1443395. Epub 2018 Feb 23.

Abstract

Premature ventricular beats (PVBs) in competitive athletes are incidentally found during pre-participation ECG screening. Their clinical significance remains debatable with several studies suggesting they are a benign reflection of athlete's heart, and others proposing they may indicate underlying structural heart disease and heightened risk for sudden cardiac death (SCD). Areas covered: Effective management of athletes with PVBs may best be accomplished using an algorithmic approach for risk stratification with a goal of differentiating benign PVBs from those reflective of underlying cardiomyopathies. Current AHA/ACC consensus recommendations provide a platform for determining optimal medical and invasive therapeutic strategies for symptom control and management of long-term complications without erroneously restricting an athlete's ability to play. Utilizing a shared decision-making model is an optimal method for managing expectations and guiding exercise recommendations. Expert commentary: Though pre-participation ECG screening as the standard of care for competitive athletes remains controversial in the United States, a 12-lead ECG is often the first indication of underlying structural heart disease in athletes with PVBs and can therefore identify athletes at greater risk of SCD. Advancements in non-invasive imaging continue to improve in diagnostic potential and prognostication. Invasive therapies provide a curative strategy for refractory PVBs and PVB-induced cardiomyopathy.

Keywords: Athlete; competitive sports; management; sudden cardiac death; ventricular arrhythmias; ventricular ectopic beats.

Publication types

  • Review

MeSH terms

  • Athletes
  • Death, Sudden, Cardiac / etiology
  • Death, Sudden, Cardiac / prevention & control*
  • Disease Management
  • Electrocardiography / methods*
  • Humans
  • Risk Assessment / methods
  • Sports Medicine
  • Ventricular Premature Complexes* / complications
  • Ventricular Premature Complexes* / therapy