Premature Ventricular Contractions: Should They be a Reason to Stop Exercising?

Premature Ventricular Contractions (PVCs) are extra contractions of the heart that are triggered from the ventricular (bottom) portion of the heart. PVCs are a relatively common event and occur in a wide range of population groups. They occur in approximately 1% of people who have a routine EKG obtain for at least 60 seconds. If 24-hour EKG testing is utilized then up to 80% of apparently healthy people will have occasional PVCs. Purely exercise-induced PVCs have been recorded to occur in 2-8% of asymptomatic individuals. Studies have demonstrated that PVCs are more common in men then women, in African-Americans, and in those with organic (structural) heart disease. The prevalence of PVCs also increases with a person’s age.

PVCs are thought to generally occur by three possible mechanisms. First, there may be a loop of electrical activity that develops in the heart and when the electricity that can trigger a heartbeat goes in a circle it can trigger an extra beat. Second, there may be conditions (electrolyte abnormalities or relative ischemia) that cause the heart cells to be too reactive to small electrical changes, which can cause a premature contraction. Third, after a normal heartbeat occurs there may be too much electricity lingering as the heart attempts to rest and it may be enough to cause an extra beat.

Individuals with PVCs generally do not experience symptoms of the extra ventricular contraction. However, some patients may become dizzy or feel as if they must stop all activities during an event. Yet it is rare that PVCs cause actual compromise of circulation and result in worrisome sequelae. The most common symptom a patient may experience is a palpitation, the feeling of the extra beat in the chest. This is cause by the heart having a larger, more powerful beat after the PVC occurred.

It is important to note that PVCs are NOT a risk factor for the development of a sustained ventricular arrhythmia (which can be life threatening) or for sudden cardiac death. However, the presence of PVCs are correlated with the presence of underlying structural heart disease. Therefore, if there are observed in a patient it is important for an evaluation for possible cardiac disease. And it is important to continue monitoring these patients based on results of various trials examining the long-term effects. Multiple studies, including the largest study on the topic, have demonstrated via follow-up of up to 23-years, that there is an increased mortality patients with PVCs and those with PVCs induced by exercise. Yet, there is some conflicting data and controversy over how the prognosis of this PVCs should be interpreted.

Again, for athletes PVCs are NOT a risk factor for the development of a sustained ventricular arrhythmia (which can be life threatening) or for sudden cardiac death. It has been shown that athletes with PVCs and have no structural heart disease do not have an increased risk of cardiovascular events while participating in exercise. In the 36th Bethesda Conference, in which various organizations gather to determine guidelines, they determined eligibility recommendations for competitive athletes with cardiovascular abnormalities

 

Recommendations:

  • “Athletes without structural heart disease who have premature ventricular complexes at rest and during exercise, and exercise testing (comparable to the sport in which they compete) can participate in all competitive sports. Should the premature ventricular complexes increase in frequency during exercise or exercise testing to the extent that they produce symptoms of impaired consciousness, significant fatigue, or dyspnea, the athlete can participate in class IA competitive sports only”

 

  • “Athletes with structural heart disease who are in high-risk groups and have premature ventricular complexes (with or without treatment) can participate in class IA competitive sports only. Such athletes with premature ventricular complexes that are suppressed by drug therapy (as assessed by ambulatory ECG recordings) during participation in the sport can compete in only class IA competitive sports.”

 

Chase King, MS-IV

David Carfagno, D.O., C.A.Q.S.M.

 

 

Resources:

Link, Mark S., MD, and Antonio Pelliccia, MD. "Arrhythmia in Athletes." Arrhythmia in Athletes. UpToDate, n.d. Web.

Manolis, Antonis S., MD. "Ventricular Premature Beats." Ventricular Premature Beats. UpToDate, n.d. Web.

Maron, Barry J., MD, FACC, and Douglas P. Zipes, MD, MACC. "36th Bethesda Conference: Eligibility Recommendations for Competitive Athletes With Cardiovascular Abnormalities." Journal of the American College of Cardiology 45.8 (2005): n. pag. Web. <https://www.sads.org/images/stories/exercise/bethesda05.pdf>.

Selzman, K. A. "Exercise-Induced Premature Ventricular Beats: Should We Do Anything Differently?" Circulation 109.20 (2004): 2374-375. Web.

 

Image 1 Credit: https://ioneblackdoctor.files.wordpress.com/2014/11/488204401.jpg?w=718&...

Image 2 Credit: https://upload.wikimedia.org/wikipedia/commons/a/a5/PVC10.JPG

 

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