Interpretation of premature ventricular contractions in athletes: a proposal for a diagnostic tool

Abstract

Regular exercise helps to prevent and treat several diseases. It is favourabel for mental health, general well-being, and benefits the heart. As you may know, physical activity elevates heart rhythm, which causes an increase in blood flow to transfer oxygen and nutrients to your muscles. Incidentally, this can be experienced during sports as a fluttering feeling in the chest or an increased awareness of the heartbeat. In most of the cases, such apparent heartbeats are completely innocent. However, the heart can incidentally have issues with coordinating heartbeats correctly, which is called heart rhythm disease or arrythmia. Most arrythmias are innocent and do not directly affect the quality of life. However, in very rare cases, arrythmias can lead to abrupt loss of heart function when not managed carefully. Recent studies found that in very rare cases, practicing intensive endurance sports can be dangerous for individuals with underlying heart disease. Your heart needs to work harder when doing intense exercise, which might be a problem if your heart is damaged. When people engaged in intensive endurance sports are not aware of possible heart rhythm problems, it can put them at higher risk for a cardiac arrest during sports activity. Therefore, it is important to inform a physician if any warranting signals regarding the heart rhythm occur. Physicians can investigate the nature of the deviating heart rhythm and assess whether it is needed to make any adaptations in lifestyle, such as imposing sport restrictions. Luckily, in most cases, a divergent heart rhythm is innocent and does not require individuals to downscale the intensity or frequency of their training ritual. However, in rare cases intense sports activity worsens prognosis of the cardiovascular health of an athlete, or even worse contributes to fatal outcome. Therefore, interference by physicians is in some cases required. Nowadays, hhysicians have several tools to determine whether athletes are at higher risk if they continue with their sport ritual. Physicians map amongst others deviating heart beats, which are also called premature ventricular beats (PVCs). These beats origin from the ventricles rather than the sinoatrial node. PVCs can be recognized on an electrocardiogram, which is a record of a person’s heartbeat. PVCs might be an indicator to determine whether a patient is at risk for SCD-related arrythmia. But how does a physician assess which PVC is innocent and which is harmful? This article provides a proposal for a tool to help physicians answering this important question. I investigated which characteristics of PVCs play an important role for this assessment. Is there a correlation between number of PVCs in 24h on a patient’s electrocardiogram and possible risk? Or is it more important how a single PVC is patterned? I also elaborate on the value of several clinical tools, such as the electrocardiography, a maximal exercise test, and cardiac magnetic resonance in case further investigation in athletes with PVCs is needed. To conclude, I summarized my findings in a flowchart, which can serve as a guideline for physicians to evaluate PVCs in athletes. This proposal might help physicians to evaluate PVCs and separate athletes which cardiovascular health is at risk because of their sport activities.