The Clinical Role of Electrocardiographic Morphology of Premature Ventricular Contractions for Prognostic Outcomes in Children.

Background and

Objectives

Premature ventricular contractions are among the most common arrhythmias encountered in clinical practice. However, this disorder can be associated with arrhythmia-induced cardiomyopathy or be the first sign of primary myocardial diseases. Certain morphologies of premature ventricular contractions are associated with a higher risk for sudden arrhythmia and cardiac dysfunction in the adult population. There is data on the clinical value and significance of the contraction morphology in adults, but there is a lack of such data for children. Materials and

Methods

This observational prospective study of pediatric outpatients with premature ventricular contractions was conducted at Vilnius University Hospital Santaros Clinics. Inclusion criteria comprised children aged 3-17 years with more than 5% premature ventricular contractions over 24 h. Exclusion criteria included previously diagnosed congenital heart defects and cardiomyopathies, channelopathies, or the presence of any acute condition. The electrocardiographic morphology and measurements were assessed, analyzed, and described in this study.

Results

The electrocardiograms of 80 patients were analyzed according to the ECG-estimated morphology of the arrhythmia complex, arrhythmic QRS complex duration, ratio with the normal QRS complex, and maximum deflection index in V5-V6 derivations. Cardiac MRI abnormalities (8 of 30 MRI studies) was reliably associated with a PVC duration of >150 ms and the maximal amount of extrasystoles per 24 h, with a median amount of 29.6%. A long postcoupling interval (>0.9 s) was associated with PVC progression.

Conclusions

In this exploratory pediatric cohort, wider PVC QRS duration and higher maximal PVC burden were associated with ventricular MRI abnormalities, while longer postcoupling interval was associated with PVC progression.