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Europace Advance Access published online on May 6, 2008
Europace, doi:10.1093/europace/eun121
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Natural history of ventricular premature contractions in children with a structurally normal heart: does origin matter?

Gertie C.M. Beaufort-Krol, Sebastiaan S.P. Dijkstra and Margreet Th.E. Bink-Boelkens*

Beatrix Children’s Hospital, Division of Pediatric Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands

Aims: Premature ventricular contractions (PVCs) are thought to be innocent in children with normal hearts, especially if they disappear during exercise. The aim of our study was to study the natural history of PVCs in childhood and whether there is a difference between PVCs originating from the right [premature ventricular contraction with left bundle branch block (PVC-LBBB)] or the left ventricle [premature ventricular contraction with right bundle branch block (PVC-RBBB)].

Methods and results: We evaluated children with frequent PVCs and anatomically normal hearts (n= 59; 35M/24F) by 12-lead ECG, echocardiography, Holter recording, and an exercise test. Age at the first visit was 7.1 ± 4.3 years (mean ± SD), and follow-up was 3.1 ± 3.1 years. We could evaluate each child for 2.5 ± 1.5 times. Premature ventricular contraction with left bundle branch block was seen in 41% of the children; PVC-RBBB in 36%; and undetermined in 23%. Mean percentage PVCs in the Holter recording decreased (14.3 ± 13.7% in the age group 1–3 years to 4.8 ± 7.2% in the age group ≥16 years; P= 0.08). Mean percentage PVC-LBBB did not change (12.3 ± 21.4 vs. 11.7 ± 5.5%), whereas PVC-RBBB decreased (16.3 ± 4.2 to 0.6 ± 1.4%; P < 0.02).

Conclusion: We conclude that there is a difference in the natural history between PVC-LBBB and PVC-RBBB in children with an anatomically normal heart. Premature ventricular contraction with right bundle branch block disappears during childhood. Follow-up of these children seems not necessary. Premature ventricular contraction with left bundle branch block does not disappear and, therefore, it may be necessary to follow these children even during adulthood.

Key Words: Natural history, Paediatrics, Premature ventricular contractions, Structurally normal heart

* Corresponding author. Tel: +31 50 3612800; fax: +31 50 3614235.E-mail address: m.t.e.bink-boelkens{at}xs4all.nl

Manuscript submitted 10 November 2007. Accepted after revision 15 April 2008.


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