Ventricular Ectopy in Children without Known Heart Disease

doi:10.1016/j.jpeds.2014.10.051

The Journal of Pediatrics

Volume 166, Issue 2, February 2015, Pages 338-342.e1

https://doi.org/10.1016/j.jpeds.2014.10.051 Get rights and content

Objective

To describe the presentation and clinical course of patients with ventricular ectopy (VE) without known heart disease seen at a single institution.

Study design

Patients with VE were identified from the cardiology database. Patients with known hemodynamically significant heart disease or systemic diseases were excluded.

Results

A total of 219 patients constitute the study population, with 59% male and median age of diagnosis 11.3 years. A total of 138 patients had follow-up data. Median duration of follow-up was 3.1 years (n = 138, range 0-21 years) for a total of 587 patient-years. Simple VE was found in 83%, and 17% had ventricular tachycardia. Most patients were asymptomatic at presentation (77%) At presentation, echocardiograms were performed in 164 patients, with 98% normal. Of the 36 patients with sequential echocardiograms, 32 (88%) remained normal, 3 (9%) had abnormal echocardiograms which normalized, and 1 (3%) had progressive left ventricular dysfunction. On sequential Holter data (n = 48), 54% showed stable or decreased VE, 40% showed resolution, and 6% showed worsening. No cases of death or resuscitated sudden death occurred.

Conclusions

Most patients were asymptomatic. There were rare cases of progression of VE and development of left ventricular dysfunction but the majority had stable findings. No deaths occurred.

Section snippets

Methods

This study was a retrospective chart review approved by the institutional review board of the University of Pittsburgh. Patients with a VE diagnosis were identified from the Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center cardiology database. The departmental cardiac database includes all patients evaluated in the Cardiology Department at this institution since 1965 (approximately 103 000 patients). Patients with structurally normal hearts and documentation of VE on

Results

A total of 501 patients with a diagnosis of VE were identified from the cardiology database search. Two hundred thirteen patients were excluded via the exclusion criteria outlined previously. Of the remaining 288 patients, medical record-derived patient data were available for 219 (76%), which constitutes the study population. A total of 130 patients (59%) were male. Median age at first visit was 11.3 years with a range of 0-26 years. Median follow-up duration was 3.1 years with a range of

Discussion

As with previous studies,2, 5 ours showed a 59% male predominance. The age at diagnosis in our study (median 11.3 years) was similar to other natural history studies.2, 3, 4, 5

More than 70% of our patient population were asymptomatic at time of diagnosis and presented with an irregular heartbeat, incidental ECG finding, or a murmur. This finding is similar to the study of Beaufort-Krol et al,⁵ in which the majority of patients had an irregular heart rhythm found incidentally and no cardiac

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Cited by (13)

Characteristics of premature ventricular contractions in healthy children and their impact on left ventricular function
2016, Heart Rhythm
Citation Excerpt :
Nevertheless, LV dysfunction and adverse cardiovascular events have been reported in the setting of frequent PVCs in numerous series of adults with structurally normal hearts, particularly when the burden of ventricular ectopy exceeds 20%–25%.7–9 In contrast, few studies have explored the association between frequent PVCs and adverse outcomes in children.3,10–15 Moreover, these studies have reported conflicting results.12,14
There are few data regarding the characteristics of premature ventricular contractions (PVCs) in healthy children and their impact on left ventricular (LV) function.
The purpose of this study was to assess the prevalence of LV systolic dysfunction in children with frequent PVCs (≥10%) and determine whether it is associated with PVC characteristics (e.g., proportion, coupling interval, width, and/or morphology).
We conducted a single-center cohort study of children with structurally normal hearts and PVC burden ≥10% by 24-hour Holter monitoring performed between 2008 and 2012. Clinical, arrhythmic, and echocardiographic data were reviewed at baseline and during follow-up.
A total of 47 children (22 female [47%], mean age 8.2 ± 6.5 years) had a mean PVC burden of 20.9 ± 11.9% at baseline. The PVC coupling interval averaged 430 ± 110 ms, with a PVC width of 118 ± 27 ms. PVCs were monomorphic in 44 patients (94%). Although no patient had severe cardiomyopathy, 7 (15%) had reduced shortening fraction (Z-score <–2). A strong association was observed between PVC coupling interval and LV shortening fraction Z-score <–2.0 (area under the curve 0.95 ± 0.03, P <.001). A cutoff value <365 ms yielded the greatest discriminatory ability (Youden J-statistic 0.72, sensitivity 85.7%, specificity 86.5%). PVC proportion, width, and morphology were not significantly associated with LV shortening fraction. During 4.0 ± 2.8 years of follow-up, the PVC burden decreased from a median of 18% to 1.5% (P<.001).
PVCs in children with structurally normal hearts are associated with a relatively benign course, with spontaneous resolution in most children. Mild LV systolic dysfunction, observed in 15%, is strongly correlated with a shorter coupling interval (<365 ms).
Cardiomyopathy induced by frequent premature ventricular contractions
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Nous rapportons l’observation d’un enfant de 7 ans atteint d’extrasystoles ventriculaires (ESV) nombreuses d’apparence bénigne et d’une dysfonction ventriculaire gauche. Le bilan cardiologique n’a pas mis en évidence d’anomalie structurale du cœur. Dix-huit mois après l’introduction d’un traitement anti-arythmique par bisoprolol à faible dose, l’enregistrement Holter a montré 70 000 ESV/24 h et la fonction ventriculaire gauche restait diminuée. Six mois après l’augmentation de la dose de bisoprolol, les ESV étaient moins fréquentes et la fonction ventriculaire gauche s’était complètement normalisée. Cette évolution est caractéristique d’une myocardiopathie rythmique induite par des ESV fréquentes.
We report on the rare case of 7-year-old child presenting with frequent and apparently benign premature ventricular complexes (VPC) and left ventricular dysfunction. No structural disease of the heart was seen at cardiological evaluation. Eighteen months after the introduction of an antiarrhythmic treatment with low-dose bisoprolol, Holter monitoring showed 70,000 VPC in 24 h with left ventricular function remaining decreased. Six months after increasing the dose of bisoprolol, the VPC were less frequent and left ventricular function was completely normalized. This case was characteristic of a cardiomyopathy induced by frequent premature ventricular contractions.
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: The authors declare no conflicts of interest.

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Original ArticleVentricular Ectopy in Children without Known Heart Disease

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

Am Heart J

J Pediatr

J Am Coll Cardiol

Am Heart J

Am J Cardiol

Am J Cardiol

Original Article
Ventricular Ectopy in Children without Known Heart Disease