Premature ventricular beats in school-age children

Abstract

Introduction. Premature ventricular beats (PVB) have been described in 40–75% of apparently healthy persons as detected by 24–48 hour ambulatory (Holter) ECG recordings. This decreases in 10% of young children and school-age children and increases in 20% -30% of normal adolescents. Pediatric studies have shown that in some asymptomatic children, an increase in the frequency of PVB can cause ventricular dysfunction and arrhythmogenic cardiomyopathy. Aim of study. Clinical-paraclinical evaluation of PVB in children with normal structural heart. Methods and materials. A descriptive analytical study was performed, which included all children of both sexes of school age (7-18 years), hospitalized consecutively in the pediatric cardiology service of the Mother and Child Institute for a period of 3 years (2019-2021). The data of the patient files were analyzed, including the results of instrumental investigations, such as standard 12-lead ECG, Holter ECG monitoring (24 hours), and echocardiography. Results. The study group included 55 children of both sexes, with a prevalence of boys (62%). From the general group, the vast majority (50 ptc, 90,9%) of children had PVB on a normal structural heart. Analysis of ECG pathways and Holter ECG protocols determined the prevalence of PVB in 16 (32%) children and 7 cases with combined extrasystoles (PVB and premature supraventricular beats, SVPV). It should be noted that in a significant number of patients (15 children) there was a combination of PVB with other arrhythmias, including 5 children with AV block and 1 case with long QT syndrome. Performing the ECG test with effort showed the disappearance or thinning of PVB in most patients, only in 4 children the test induced arrhythmia. Echocardiography performed in all patients in the study confirmed the presence of arrhythmogenic cardiomyopathy criteria in 6 (12%) of cases (dilation of the left or right ventricular cavity ˃ 2 z score, decreased ventricular ejection fraction ˂ 60%). Regardless of the symptoms, both patients with cardiomyopathy and children with frequent, polymorphic and allorhythmia type of PVB or SVPB administered chronic antiarrhythmic treatment, mainly beta-blockers (83.9%) of the 2nd or 3rd generation. Evaluation of patients at 2.5-3 months confirmed the efficacy of treatment by clinical ECG and echocardiographic improvement. No side effects have been reported. Conclusion. PVB is frequent asymptomatic arrhythmia in school-age children. Some children (12%) may evaluate with ventricular dysfunction or cardiomyopathy. Beta-blockers may be used for symptom control and improve systolic ventricular function.