Clinical correlates and outcome of the patterns of premature ventricular beats in Olympic athletes: a long-term follow-up study

Background The pattern of premature ventricular beats, as a clue to site of origin, may help identify underlying cardiac diseases. Aim To assess the value of premature ventricular beat patterns in managing athletes with ventricular arrhythmias. Methods Athletes with 50 or more isolated premature ventricular beats/24 hours, and/or multifocal and/or repetitive premature ventricular beats at baseline, and/or exercise, and/or 24-hour electrocardiograms were selected for this analysis. Premature ventricular beats were defined as ‘common’ (outflow tract or fascicular origin), or ‘uncommon’ (other morphologies and/or multifocal or repetitive). Results From 4595 athletes consecutively examined, 205 (4%, 24.6 ± 6.9 years, 67% men) were included, 118 (58%) with uncommon and 87 (42%) with common premature ventricular beats. In particular, 81 (39%) showed complex patterns; 63 (31%) right/left ventricular outflow tract origin; 24 (12%) fascicular origin; 20 (10%) right bundle branch block pattern, intermediate/superior axis, wide QRS; and 17 (8%) left bundle branch block pattern, intermediate/superior axis. Uncommon premature ventricular beat patterns were predominant among men (62% vs. 38%; P < 0.001) but not among women. Uncommon premature ventricular beats were equally prevalent in endurance, mixed and skill disciplines, but lower in power sports. Cardiac diseases were detected in 11 (5%), 10 with uncommon patterns. Over a 6-year follow-up, cardiac diseases occurred in four (0.6%/year), all with uncommon patterns. Overall, cardiac diseases at baseline and during follow-up were detected in 14/118 athletes with uncommon versus one/87 with common premature ventricular beats ( P = 0.003). Conclusions Evaluation of premature ventricular beat patterns in Olympic athletes identified cardiac diseases, requiring disqualification and/or follow-up, in 12% with uncommon versus 1% with common patterns. This result suggests that athletes with uncommon premature ventricular beat patterns should undergo comprehensive cardiac evaluation and/or serial follow-up, irrespective of gender or sporting discipline.

Epicardial ablation of premature ventricular beat from right ventricular outflow tract following ineffective endocardial ablation

A case of epicardial ablation of premature ventricular beat (PVB) originating in RVOT outflow tract in an 18-year old patient with frequent symptomatic drug-induced PVB after ineffective endocardial ablation is described. Multiple RF applications by using an irrigated catheter on the side of RVOT turned out ineffective. During epicardial mapping the source of PVB also was in the RVOT area, but with a greater relative and absolute lead. In the course of epicardial ablation, PVB tended to 'heat up', pass into ventricular tachycardia followed by the tatter's arrest and then disappear. At 12-month follow-up the patient showed no ventricular arrhythmias without any antiarrhythmic drugs.

Body Surface Electrocardiographic Mapping for Non-invasive Identification of Arrhythmic Sources

The authors describe a novel three-dimensional, 252-lead electrocardiography (ECG) and computed tomography (CT)-based non-invasive cardiac imaging and mapping modality. This technique images potentials, electrograms and activation sequences (isochrones) on the epicardial surface of the heart. This tool has been investigated in the normal cardiac electrophysiology and various tachyarrhythmic, conduction and anomalous depo-repolarisation disorders. The clinical application of this system includes a wide range of electrical disorders like atrial arrhythmias (premature atrial beat, atrial tachycardia, atrial fibrillation), ventricular arrhythmias (premature ventricular beat, ventricular tachycardia) and ventricular pre-excitation (Wolff-Parkinson-White syndrome). In addition, the system has been used in exploring abnormalities of the His-Purkinje conduction like the bundle branch block and intraventricular conduction disturbance and thereby useful in electrically treating the associated heart failure (cardiac resynchronisation). It has a potential role in furthering our understanding of abnormalities of ventricular action potential (depolarisation [Brugada syndrome and repolarisation], long QT and early repolarisation syndromes) and in evaluating the impact of drugs on His-Purkinje conduction and cardiac action potential.