The Impact of High Burden Idiopathic Premature Ventricular Contractions in Pediatric versus Adult Populations. A Retrospective Cohort Study
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Published on: January 12, 2024
Lamyaa Elsayed Allam1, Mervat Aboulmaaty Nabih2, Mohamed Basyouni Helal3
1Cardiology Department, Faculty of Medicine, Ain Shams University, 48 Mohammed Elnadi Street, 6Thzonezone, Nasr CityCairo, P0 11371, Egypt. lamyaa_allam@med.asu.edu.eg.
Insights
High-burden idiopathic premature ventricular contractions (PVCs) present differently in children versus adults, with children experiencing more syncope and distinct origins. Radiofrequency ablation outcomes are similar for both age groups.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Electrophysiology
Background:
- Idiopathic premature ventricular contractions (PVCs) affect up to 40% of children with healthy hearts.
- Understanding age-related differences in PVCs is crucial for diagnosis and management.
Purpose of the Study:
- To compare the clinical impact, origin, and management of high-burden idiopathic PVCs in children versus adults.
- To evaluate the safety and efficacy of radiofrequency (RF) ablation in pediatric and adult patients with frequent PVCs.
Main Methods:
- A single-center retrospective cohort study included 224 patients with >10% PVC burden on Holter monitoring.
- Patients were divided into pediatric (<18 years) and adult (≥18 years) groups.
- Data collected included demographics, symptoms, echocardiography, ECG, and one-year follow-up post-management.
Main Results:
- Syncope was significantly more frequent in children (15.8%) than adults (0.9%).
- PVCs predominantly originated from the right ventricular outflow tract (RVOT) in children (40%), while adults had more septal RVOT origins.
- Outflow tract PVCs were more common in pediatric cases (92.5% vs. 69.2%).
Conclusions:
- Age influences syncope incidence and PVC origin in idiopathic cases.
- Radiofrequency catheter ablation demonstrated comparable safety and efficacy for both pediatric and adult populations.
- No significant differences were observed in PVC-induced myopathy prevalence or ablation outcomes between age groups.
Abstract:
Idiopathic premature ventricular contractions (PVCs) can occur in up to 40% of children with structurally normal hearts. The study aims to assess the impact of high-burden idiopathic PVCs on children in comparison with adults in terms of symptoms, distribution of origin, management strategies, and safety considerations. This is a single-center retrospective cohort study that included patients with frequent PVCs (> 10% burden in Holter monitoring) and categorized by age into adult group (≥ 18 years) and pediatric group. Data encompassed demographic profiles, clinical symptoms, echocardiographic findings, electrocardiographic analyses, and one-year follow-up management. A total of 224 PVC cases were collected during a 2-year study (120 children and 104 adults). Syncope occurred significantly more in children than adults (15.8% vs. 0.9%, p = 0.003). In children, the right ventricular outflow tract (RVOT) free wall was the predominant site (48 patients; 40%), while the septal RVOT was most common in adults (35 patients; 33.7%). Pediatric cases exhibited significantly higher PVCs originating from the outflow tract (92.5% vs. 69.2%; p = 0.001). Nevertheless, there were no significant differences between groups regarding the safety, acute, and one-year outcomes of RF ablation. Age disparities were evident in syncope incidence and PVC origin, with no variance in PVC-induced myopathy prevalence or the safety and outcomes of RF catheter ablation between children and adults.
