Predictors of Ventricular Abnormalities in Children with Idiopathic Ventricular Extrasystoles

TL;DR

This study examines how ventricular extrasystoles in children relate to heart abnormalities and finds a strong link between high extrasystole frequency and ventricular dysfunction.

Contribution

The study identifies ventricular dysfunction as a key predictor linked to a higher burden of ventricular extrasystoles in children.

Findings

Ventricular dysfunction was associated with a median extrasystole frequency of 26.5% per 24 hours.

Pathological findings from cardiac MRI were found in one-third of the patients examined.

Most ventricular extrasystoles in children were monomorphic and often discovered incidentally.

Abstract

Background and Objectives: Ventricular extrasystoles, which are the most common arrhythmias in healthy children and adolescents, could be a reliable factor for the prognosis of structural heart diseases. However, extrasystoles arising in hearts with primary myocardial diseases or channelopathies might cause life-threatening events or be associated with arrhythmia-induced cardiomyopathy. The relationship between ventricular extrasystoles and ventricular abnormalities in children remains controversial. The aim of this study was to evaluate prevalence of ventricular abnormalities in children with ventricular extrasystoles. Materials and Methods: This was a retrospective cohort study of pediatric outpatients in Vilnius University Hospital Santaros Clinics because of ventricular extrasystoles. The inclusion criteria were 3–18-year-old children with more than 5% extrasystoles per 24 h. The exclusion criteria were previous diagnoses of congenital heart defects, cardiomyopathies, and channelopathies. We reviewed the results of electrocardiography, cardiac imaging, and cardiogenetic tests. Results: In total, 131 patients (55.7% males) were included from a database of 915 patients, of whom 79.4% ventricular extrasystoles were found incidentally. Ventricular extrasystoles were monomorphic—95.4%, multiform—4.6%, and consecutive—29.8%. Cardiac magnetic resonance imaging was performed on 22.9% of patients with one-third of the pathological findings (ventricular dysfunction and myocardial fibrosis). Ventricular dysfunction was associated with a higher frequency of ventricular extrasystoles, with a median highest frequency of 26.5% per 24 h. Cardiogenetic testing was performed on only five (3.8%) patients, and RyR2 mutation was detected in one. Conclusions: According to our results, ventricular dysfunction was strongly associated with a higher burden of ventricular extrasystoles.

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