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Case Reports
. 2022 May 16;6(5):ytac174.
doi: 10.1093/ehjcr/ytac174. eCollection 2022 May.

The role of pre-participation cardiac evaluation in the management of an athlete with premature ventricular contraction-induced cardiomyopathy: a case report

Javad Norouzi  1   2 , Michael Papadakis  3 , Ali Akbarnejad  1 , Mehdi Anvari  2
Affiliations
Case Reports

The role of pre-participation cardiac evaluation in the management of an athlete with premature ventricular contraction-induced cardiomyopathy: a case report

Javad Norouzi et al. Eur Heart J Case Rep. .

Abstract

Background: Premature ventricular contractions (PVCs) are commonly observed during pre-participation cardiac screening in elite athletes. There is an ongoing debate about the clinical significance of PVCs in athletes and whether burden, morphology, or both should be used to differentiate benign PVCs from PVCs suggestive of cardiac disease.

Case summary: A 28-year-old male athlete was evaluated as part of the pre-participation screening programme. He was asymptomatic, without specific cardiac signs and symptoms. A 12-lead electrocardiogram showed bigeminy PVCs with infundibular morphology and left ventricular outflow tract origin. Left ventricular dilatation and systolic dysfunction without valvular lesions was detected on echocardiography. Cardiac magnetic resonance imaging showed biventricular dilatation and dysfunction without evidence of myocardial fibrosis or fatty infiltration. A 48 h Holter monitoring showed 75191 PVCs (35% of total beats). Radiofrequency ablation was performed, and post-ablation assessments showed no PVCs with normalized ventricular function and dimension.

Discussion: This case demonstrated that a high PVC burden of common morphology does not also represent a benign finding and requires a comprehensive evaluation to rule out any pathological condition. Furthermore, the present case highlights the critical role of pre-participation cardiac evaluation in identifying cardiac disease in asymptomatic athletes.

Keywords: Ablation; Case report; PVC-induced cardiomyopathy; Pre-participation cardiac evaluation; Premature ventricular contractions.

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Figures

Figure 1
Figure 1
The resting 12-lead electrocardiogram of a 28-year-old male asymptomatic CrossFit athlete shows bigeminy premature ventricular contractions with an infundibular pattern, characterized by a typical left bundle branch block, inferior ORS axis morphology with small R-waves in V1, and earlier QRS transition before V3, indicative of an left ventricular outflow tract ectopic focus. PVCs, premature ventricular contractions; LBBB, left bundle branch block; LVOT, left ventricular outflow tract.
Figure 2
Figure 2
3D mapping by Navx confirmed the left ventricular outflow tract origin of premature ventricular contractions. LVOT, left ventricular outflow tract; PVCs, premature ventricular contractions.
Figure 3
Figure 3
Post-ablation 12-lead electrocardiogram shows sinus rhythm without premature ventricular contraction. PVCs, premature ventricular contractions.
None
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