Premature ventricular beats in young athletes: interpretation and diagnostic pathway

Abstract

Adolescents and adults with cardiovascular disease who are engaged in sports activity have an increased risk of sudden cardiac death (SCD) related to the sports practice that acts as a trigger for life-threatening ventricular arrhythmias. Premature ventricular beats (PVBs) detected in athletes at the time of pre-participation screening may be a sign of heart disease at risk of SCD but are also found in athletes without cardiovascular abnormalities. Thus, the interpretation of PVBs could represent a clinical dilemma. However, while some characteristics of PVBs can be considered common and benign, others occur uncommonly in the athletic population and raise the suspicion of underlying cardiovascular disease. This review discusses the prevalence and the clinical significance of PVBs in the athlete, with a focus on exercise-induced PVBs, on the analysis of PVB's morphology at 12-lead ECG, and on the morphological substrates identified by imaging techniques. The implications on eligibility for competitive sports participation are also discussed, according to the relevance of PVBs detection for disqualifying athletes from competitions.