Revisiting exercise-induced premature ventricular complexes as a prognostic factor for mortality in asymptomatic patients: A systematic review and meta-analysis

Are Exercise-Induced Premature Ventricular Contractions Associated with Significant Coronary Artery Disease?

Objectives: Exercise-induced premature ventricular contractions (EIPVC) have been associated with higher mortality, but the association with coronary artery disease (CAD) has not been precisely established. Our objective was to assess in a group of subjects with EIPVC and cardiovascular risk factors the association with underlying significant coronary artery disease (CAD), in comparison with a control group of patients with cardiovascular risk factors and exercise test (ET) showing ischaemia. Methods: All the patients (above 35 years old) referred for ET at our institution were prospectively included. Patients with at least one cardiovascular risk factor and without known CAD were divided into 2 groups: group A if EIPVC were present (either during exercise or during recovery), at least more than 10% over 30 s of recording; group B if ET was showing ischaemia. The presence of CAD was then confirmed in both groups by coronary arteriography, and/or thallium scintigraphy, and/or cardiac MRI and/or coronary CT angiography performed within 2 months after ET realization. Results: From November 2020 to December 2022, 4098 ETs were performed. After exclusion (normal ETs = 2194; known CAD = 1109; age < 35 years old = 487; congenital heart disease = 59; mitral valve prolapse = 4), 46 patients with EIPVC were finally identified (male 65%, mean age 61.5 ± 11 years), and 71 in group B. CAD was confirmed using additional tests in 5/46 (11%) patients in group A versus 38/71 (54%) in group B (p < 0.0001). Conclusions: Amongst patients without known CAD, the presence of EIPVC was less frequently associated with an underlying CAD, compared to the presence of exercise-induced "electrical" ischaemia.

The Influence of Lifestyle Factors on the Occurrence and Severity of Premature Ventricular Contractions: A Comprehensive Review

Premature ventricular contractions (PVC) are a type of ventricular arrhythmias, occurring as a result of formation or reentry of an abnormal impulse in the ventricular myocardium or in the Purkinje system. PVC occurs commonly in healthy individuals and is observed in 1%-4% of the population. Several lifestyle factors like stress levels, caffeine, drugs, alcohol, nicotine, sleep, and physical exercise have been implicated in increasing the risk. Caffeine and drugs precipitate heightened cardiac stimulation, precipitating PVCs. Excessive alcohol and nicotine disturb the electrical pathways resulting in PVCs. Higher rates of PVCs have been associated with obesity. Individuals with insomnia and increased stress levels are also at an increased risk due to an imbalance in the autonomic system. Exercise is known to induce PVCs, including in healthy, asymptomatic individuals. Modification of these factors can decrease PVC risk. This article aims to provide a comprehensive review of the effects of lifestyle factors on PVC.