Department of Cardiovascular Medicine (S.E.G., M.V.P., M.T.W., D.S.K., V.F.), Stanford University School of Medicine, CA.
Cardiac Insight, Inc, Bellevue, WA (D.H.).
Circ Arrhythm Electrophysiol. 2024 Sep;17(9):e012835. doi: 10.1161/CIRCEP.124.012835. Epub 2024 Aug 28.
Large-scale data on incidental premature ventricular contraction (PVC) prevalence and morphologies have been lacking, leaving many providers without guidance on further cardiac testing for patients with incidental PVCs on ECG. Athletes offer an intriguing cohort to understand the clinical significance, prevalence, and common morphologies of incidental PVCs because they often undergo ECG screening during preparticipation exams.
Digital ECGs were obtained from 10 728 screened athletes aged 14 to 35 years during mass screenings in schools and professional sports teams between 2014 and 2021. A retrospective analysis of ECGs with PVCs was performed using the simultaneous display of frontal (limb) and horizontal (precordial) plane leads. PVCs were coded for morphology and categorized as benign or nonbenign using recommended criteria.
Twenty-six athletes (0.24%) were found to have at least 1 PVC. Among these, 50% were female, 65% were White, 8% were Asian, 4% were Hispanic, and 23% were Black. Nineteen of the 26 (73%) ECGs had PVCs with a left bundle branch block pattern compared with 7 (27%) with a right bundle branch block pattern. Twenty-four ECGs (96%) had PVCs with benign patterns, including 18 with right ventricular outflow tract, 5 with left anterior fascicle, and 2 with left posterior fascicle morphology.
There is a low prevalence of PVCs on routine ECG screening of young athletes, and most PVCs are of benign morphology in this population. This study highlights the value of using digital ECG recorders with simultaneous lead display to guide decision-making about further cardiac testing and referrals in young athletes with PVCs. Using our results and review of the literature, we propose methods and algorithms of PVC evaluation on screening ECGs to help guide many providers with risk stratification and decision-making about further cardiac testing and electrophysiology referrals in young athletes with PVCs.
关于偶发性室性早搏 (PVC) 的发生率和形态学，缺乏大规模的数据，导致许多医生在对心电图偶发性 PVC 患者进行进一步心脏检查时缺乏指导。运动员是一个有趣的群体，可以帮助我们了解偶发性 PVC 的临床意义、发生率和常见形态，因为他们在参加体育活动前通常会接受心电图筛查。
在 2014 年至 2021 年期间，对学校和职业运动队中 10728 名 14 至 35 岁的筛查运动员进行数字心电图检查。使用额面（肢体）和横面（胸前）导联同步显示，对心电图中有 PVC 的患者进行回顾性分析。根据推荐标准，将 PVC 按形态进行编码，并分为良性或非良性。
在 26 名运动员（0.24%）中发现至少有 1 次 PVC。其中，50%为女性，65%为白人，8%为亚洲人，4%为西班牙裔，23%为黑人。26 名运动员中有 19 名（73%）心电图的 PVC 呈左束支传导阻滞形态，而 7 名（27%）呈右束支传导阻滞形态。24 名（96%）心电图的 PVC 呈良性形态，其中 18 名起源于右室流出道，5 名起源于左前分支，2 名起源于左后分支。
在对年轻运动员进行常规心电图筛查时，PVC 的发生率较低，而且在该人群中，大多数 PVC 的形态为良性。本研究强调了在心电图筛查中使用数字心电图记录器和同步导联显示来指导年轻运动员 PVC 进一步心脏检查和转诊决策的价值。根据我们的结果和文献复习，我们提出了在筛查心电图上评估 PVC 的方法和算法，以帮助许多医生对有 PVC 的年轻运动员进行风险分层和决定是否进一步进行心脏检查和电生理检查。
