Assessment of premature ventricular beats in athletes

Premature ventricular complexes (PVC) are generally considered as a benign electrocardiographic abnormality in the athletic population. However it may be indicative of underlying heart disease which may increase the risk of sudden death. This implies the need for cardiological evaluation before indicating the ability to practice competitive sports.

The aim of this study was to evaluate an athlete population with PVC and establish underlying etiologies in order to take a decision regarding practicing sports.

This is a prospective study which included athletes examined in the Tunisian National Centre of Sports Medicine and Sports Science (TNCSM) from January 2013 to June 2015 who presented PVC on an electrocardiogram.

Five thousand seven hundred and ninety eight athletes were referred to the TNCSM. We identified 42 athletes having PVC with a prevalence of 1.8%. The average age of the study population was 21.6±5.99 years. 83% were men. 88% were asymptomatic. The electrocardiogram was considered normal in 62% of the athletes according to the Seattle criteria. At the Holter monitoring, the average number of PVC was 920 PVC/24hours. Thirteen athletes had doublets and 11 had triplets. One patient had polymorphic PVC and an R/T phenomenon. The transthoracic echocardiography (TTE) was normal in 71% of cases. Three athletes had hypertrophic cardiomyopathy (HCM). All patients underwent a stress test. The PVC disappeared in 12% of athletes MRI was performed in 10 athletes confirming the three cases of HCM and revealing a case of arrhythmogenic right ventricular dysplasia and a case of compression of the right ventricle by pectus exacavatum.

After this assessment, five athletes were not allowed to practice sport. This study shows the necessity of a thorough cardiological assessment of athletes with ventricular arrhythmia in order to detect underlying heart disease and prevent sudden death in this young apparently healthy population.