From the Guidelines
Premature ventricular contractions (PVCs) in infants and children are often asymptomatic and typically have a benign clinical presentation, with most cases resolving spontaneously with age 1. The clinical presentation of PVCs in infants and children can vary, but they are often discovered incidentally during routine examinations. When symptoms do occur, they may include:
- Palpitations, described by older children as a "skipped beat" or "flip-flop" sensation in the chest
- Lightheadedness, chest discomfort, or fatigue, particularly when PVCs are frequent
- Infants with PVCs may show irritability, poor feeding, or tachypnea if the PVCs are causing hemodynamic compromise On physical examination, an irregular heart rhythm with occasional stronger beats may be detected, and auscultation reveals early beats followed by a compensatory pause. It is recommended that asymptomatic children with frequent isolated PVCs or an accelerated ventricular rhythm and normal ventricular function be followed-up without treatment, as most cases are benign and resolve spontaneously with age 1. PVCs in children are often benign, especially isolated PVCs in patients with structurally normal hearts. However, certain patterns such as multifocal PVCs, couplets, or ventricular tachycardia episodes warrant further evaluation. PVCs that increase with exercise rather than decreasing (as is typical) may suggest underlying cardiac pathology. The clinical significance of PVCs depends on their frequency, complexity, and the presence of underlying heart disease, with most isolated PVCs in otherwise healthy children having an excellent prognosis and often resolving spontaneously with age 1.
From the Research
Clinical Presentation of Premature Ventricular Contractions (PVCs) in Infants and Children
The clinical presentation of PVCs in infants and children can vary, but generally, they are asymptomatic and have a benign prognosis 2. Some common characteristics of PVCs in children include:
- Isolated PVCs, couplets, or triplets on Holter monitoring 3, 2
- Unifocal or multifocal PVCs 2
- Presence of nonsustained ventricular tachycardia in some cases 3, 2
- Decrease or disappearance of PVCs during exercise in some children 2
Diagnostic Evaluation
The diagnostic evaluation of PVCs in children typically involves:
- Holter monitoring to assess the frequency and characteristics of PVCs 3, 2
- Exercise testing to evaluate the response of PVCs to physical activity 2
- Electrocardiogram (ECG) to assess the morphological characteristics and origins of PVCs 4
- Echocardiography to rule out underlying structural heart disease 5, 6
Risk Factors and Prognosis
Some children with PVCs may be at risk of developing left ventricular dysfunction or cardiomyopathy, particularly those with:
- High-burden PVCs (> 30,000/24 hours) 3, 6
- Presence of couplets, triplets, or nonsustained ventricular tachycardia 3, 2
- Symptoms such as palpitations or signs of heart dysfunction 5, 6 However, the overall prognosis of PVCs in children is generally benign, and many cases resolve spontaneously or improve over time 3, 2.