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June 12, 2026European Journal of Preventive CardiologyOpen Access

Ventricular arrhythmias in athletes: morphologic features and risk stratification of pathological myocardial substrate

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Why the study?

Do specific clinical, ECG, and arrhythmic features predict underlying cardiovascular disease in competitive athletes with premature ventricular beats?

Population

264 competitive athletes with premature ventricular beats on 24-hour ambulatory ECG and/or exercise testing…

Design

Cross-sectional

Key result

Polymorphic PVBs (69% vs 37.5%, p<0.001), reproducible PVBs, and specific RBBB morphologies independently predicted underlying cardiac disease, which was identified in 32% of athletes with PVBs.

Authors

FGF GrazianoCCC CarluccioAAA De Antoni

Discussion

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Overview

May aid risk stratification in athletes with PVBs; leaves open prospective validation of predictors.

Key Points

  • The aim is to identify clinical and ECG features that predict cardiovascular disease in athletes with premature ventricular beats.
  • Evaluated 264 competitive athletes for premature ventricular beats during pre-participation screening.
  • Performed cardiac magnetic resonance and genetic testing when clinically indicated.
  • Assessed clinical history and analyzed ventricular arrhythmias for complexity and morphology.
  • 32% of athletes had identified cardiac disease, including arrhythmogenic conditions.
  • Baseline ECG abnormalities were found in 45% of athletes with disease compared to 26.8% without (p=0.007).
  • Independent predictors of pathological substrate included RBBB morphology and specific ECG features with high statistical significance.

Study Design

Type

Observational (n=264)

Structured PICO

Do specific clinical, ECG, and arrhythmic features predict underlying cardiovascular disease in competitive athletes with premature ventricular beats?

P
Population
264 competitive athletes (median age 39, 21% female) with premature ventricular beats and no known cardiovascular disease undergoing second-level evaluation.
E
Exposure
Clinical, ECG, and arrhythmic feature assessment (including cardiac magnetic resonance and genetic testing when clinically indicated)
O
Outcome
Presence of underlying cardiovascular disease (pathological myocardial substrate)

In competitive athletes with premature ventricular beats, specific clinical and ECG features such as polymorphic PVBs and RBBB morphology with specific axis and deflection characteristics strongly predict underlying structural heart disease.

Cite This Study

Graziano et al. (2026) conducted an observational in Premature ventricular beats in athletes (n=264). Clinical, ECG, and arrhythmic features vs. Absence of these features was evaluated on Underlying cardiac disease. Polymorphic PVBs (69% vs 37.5%, p<0.001), reproducible PVBs, and specific RBBB morphologies independently predicted underlying cardiac disease, which was identified in 32% of athletes with PVBs.

synapsesocial.com/papers/6a2bd11d6550ea4541ffe8adhttps://doi.org/10.1093/eurjpc/zwag249.364
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Modern Interpretation of Electrocardiogram and Premature Ventricular Beats in Athletes2025
  2. 2Athlete’s Heart or Heart at Risk? Cardiac Remodeling and Exercise-Induced Ventricular Arrhythmias in Elite Athletes2025
  3. 3Premature Ventricular Contractions as a Result of Subacute Myocarditis in a Professional Football Player2026
  4. 4Mitral Valve Prolapse in Athletes: Prevalence, Arrhythmic Associations, and Clinical Implications — A Systematic Review2025
  5. 5Catheter ablation of idiopathic premature ventricular contractions in athletes without structural heart disease: impact on arrhythmic burden and return to sport2026