Premature ventricular contraction-induced ventricular dysfunction in children without structural heart disease: a systematic review and meta-analysis.

Aims: Premature ventricular contractions (PVCs) in paediatric patients often present a benign course. However, a minority of patients may develop left ventricular (LV) dysfunction, and risk factors are still under debate. The aim of this systematic review and meta-analysis was to analyse the prevalence of PVC-induced cardiomyopathy (CMP) and understand the risk factors in paediatric patients with PVCs and structurally normal hearts.

Methods and results: A systematic search strategy was performed to identify original reports published between 1 January 2000 and 31 August 2024. Studies including adult patients and patients with cardiomyopathies, congenital heart diseases, or channelopathies were excluded. Seventeen studies were included and comprised 1.701 patients, with a mean age of 11.4 years. The mean burden of PVCs across the included studies was 16% (12.2-19.7). Left ventricular systolic dysfunction occurred in 40 patients, and they showed older age at presentation. Premature ventricular contraction burden emerged as significant risk factor for PVC-induced CMP (mean burden among patients with and without LV dysfunction 32.5 and 15.47%, respectively). Shorter coupling intervals and longer QRS duration were predictors in a few studies. No major adverse cardiovascular events occurred. Left ventricular dysfunction recovered in all but one patient after spontaneous or pharmacologically induced PVC reduction. Class IC drugs showed greater efficacy than other drugs.

Conclusion: Premature ventricular contraction-induced CMP is rare in children, and PVC burden is the key determinant of risk. The threshold burden associated with LV dysfunction is higher in paediatric patients than in adults. Most patients with PVC-induced CMP experience normalization of LV function during follow-up.