From the Guidelines
Premature ventricular contractions (PVCs) in newborns are generally benign and do not have adverse prognostic significance in the absence of underlying heart disease, as indicated by the 2006 guidelines for management of patients with ventricular arrhythmias 1.
Concerns Associated with PVCs in Newborns
The primary concern with PVCs in newborns is the potential for underlying cardiac abnormalities, such as congenital heart defects, electrolyte imbalances, or myocardial inflammation. However, isolated PVCs are common in infants, with 15% of all newborns reported to have some ventricular ectopy during 24-hour ambulatory ECG monitoring 1.
Evaluation and Treatment
Evaluation of PVCs in newborns typically includes:
- A 12-lead ECG to assess cardiac rhythm and structure
- Echocardiogram to evaluate cardiac function and rule out structural abnormalities
- Laboratory tests to check electrolyte levels and rule out infection
- Continuous cardiac monitoring to determine the frequency and pattern of PVCs Treatment depends on the underlying cause and may include correcting electrolyte abnormalities, adjusting medications, or specific cardiac interventions if structural heart disease is present.
Prognosis and Follow-up
While isolated PVCs may resolve spontaneously as the heart matures, frequent PVCs or those associated with symptoms require cardiology consultation and close follow-up to prevent potential complications like heart failure or more serious arrhythmias. According to the 2015 eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities, PVCs observed in athletes without heart disease may decrease on deconditioning and reappear with reconditioning, but this pattern does not indicate independently heightened risk in the absence of other risk markers 1.
Key Considerations
- PVCs in newborns are common and generally benign in the absence of underlying heart disease
- Evaluation and treatment should focus on identifying and addressing underlying cardiac abnormalities
- Close follow-up is necessary to prevent potential complications and ensure optimal outcomes.
From the Research
Concerns Associated with Premature Ventricular Contractions (PVCs) in Newborns
- PVCs are generally considered benign, but they can lead to the development of cardiomyopathy and, rarely, can be associated with sudden cardiac death 2
- In children, PVCs are common and tend to resolve spontaneously in most cases, but frequent PVCs may indicate an arrhythmia-induced cardiomyopathy requiring medical or catheter ablation 3
- The presence of PVCs in children with structurally normal hearts is usually benign, but it is essential to rule out structural heart disease and determine whether symptoms are due to PVCs or left ventricular dysfunction 4
- A higher burden of PVCs is a risk factor for the development of PVC-induced cardiomyopathy (PIC), which can be evaluated using imaging modalities such as echocardiography and cardiac magnetic resonance imaging 5
- In the presence of structural heart disease, PVCs may indicate an increased risk of sudden death, and high PVC burden may induce cardiomyopathy and left ventricular dysfunction or worsen underlying cardiomyopathy 6
Diagnostic and Therapeutic Considerations
- Rhythm evaluation by 12-lead ECG and ambulatory monitoring device are essential for diagnosing PVCs 5
- Diagnostic procedures such as physical examination, electrocardiogram, ambulatory monitoring, exercise testing, echocardiography, cardiac magnetic resonance imaging, coronary angiography, and electrophysiology study can help differentiate benign and malignant PVCs 6
- Treatment options include lifestyle modification, electrolyte imbalance correction, medical therapy, and catheter ablation 5, 6