Cardiopulmonary Capacity is Reduced in Children with Ventricular Arrhythmia

BACKGROUND Premature ventricular contractions (PVCs) are frequently seen in children and are considered benign. A substantial group of adolescents with PVCs complain about a broad range of clinical symptoms, including low exertion tolerance. OBJECTIVE The purpose of this study was to evaluate prospectively whether ventricular arrhythmia affects physical performance in adolescents with normal left ventricular function, using a cardiopulmonary exercise test (CPET) and evaluating the electrocardiographic (ECG) characteristics of patients with PVCs with regard to exercise capacity. METHODS The study group consisted of 49 children with PVCs and normal left ventricular function. The control group consisted of 36 healthy volunteers. Standard ECG, 24-hour Holter ECG, and CPET were performed. PVCs were analyzed for QRS duration, bundle branch block pattern, QRS axis, and coupling interval (CInt). For CPET, heart rate (HR), oxygen uptake (VO2max), predicted VO2max, and VO2max expressed as a percentage of the predicted value (%VO2) were measured. RESULTS In 37 patients (76%), arrhythmia subsided during exercise. Patients achieved lower VO2max (32.9 +/- 6.3 mL/min/kg) than controls (40.4 +/- 6.7 mL/min/kg; P <.01). %VO2 was 71.0 +/- 13.7 in patients and 79.3 +/- 12.2 in controls (P <.01). Exercise HR at which PVCs subsided correlated with VO2max (r - 0.3; P - .07). Patients with persisting arrhythmia performed worse than those in whom arrhythmia subsided during exercise (VO2max, P <.01; %VO2, P <.01). No correlation between QRS and CInt parameters and VO2max was observed. CONCLUSION Patients with PVCs have lower aerobic capacity than their healthy peers. Further worsening of exercise capacity is present when PVCs are preserved during effort. (Heart Rhythm 2023;20:554-560) (c) 2022 Heart Rhythm Society. All rights reserved