Interpretation and Diagnostic Workup of Premature Ventricular Beats

Athletes with premature ventricular beats (PVBs) are not rare. The risk of malignant ventricular arrhythmias depends on the presence of an underlying pathological myocardial substrate. The standard diagnostic workup includes family and personal history, resting ECG, 24-h ambulatory ECG (possibly with 12-lead and including a training session), maximal exercise testing, and echocardiography. However, normal first-line investigation does not definitely rule out the presence of a concealed substrate (such as ventricular scars) that can be revealed only by more in-depth investigations (particularly cardiac magnetic resonance). Features that can help estimating the probability that the PVBs are linked to a heart disease and that suggest the need for second-level testing include morphology, complexity, and inducibility by exercise.