Dear John,
Unfortunately, despite the information that you have given me, I cannot tell you your child’s risk. For our other readers, the Lown grading system is a system of assessment of frequency and severity of premature ventricular contractions (PVCs) that is used in adults. It has not been validated for use in children, and we do not know what it really means from a prognostic standpoint. Lown grade IV can be broken into two types: IV A, which includes couplets (two PVCs together) or IV B, which includes runs of 3 or more PVCs. There is much more to evaluating PVCs than just how many there are and if they suppress with exercise, including what pattern they have, where they occur in the heart, if they are uniform vs. multiform, and some other factors. It sounds like there has been a significant amount of testing that has been done on not just your son, but also on your entire family. I recommend that you be seen by a pediatric electrophysiologist who would be familiar with the evaluation.
I can say that approximately 20% of adolescent males have benign PVCs on routine testing, though I cannot tell if your son’s is benign, or not. We don’t typically worry about couplets, including the need for medication for them, if they are infrequent and do not worsen with exercise. We do like to routinely follow these patients with, at minimum, Holter monitoring to ensure that the frequency and severity of the ectopy is not increasing.
Contiunued
My questions are many, and my concern is deep. My child is an exceptional scholar athlete who participates in football, baseball, and soccer. The doctors keep telling us its a wait and see approach, as they manipulate his medication for 30 day cycles and follow up with holter tests.
I find the waiting and the unknown the worst to deal with. He has been seen by three different doctors, and at times it appears as though they have differing opinions. Then they confer and give a concensus recommendation.
What are the statistics regarding children with these types of diseases?
Assuming his condition does not change for the worse but remains the same, what can thes future hold as far as sports and an active lifestyle?
Can they return to active sports (Soccer , Football)?
Can they return to quasi physically demanding sports (ie Baseball).
What can we expect as our child enters puberty and adulthood?
Thank you for your consideration.
My son's case is receiving contrasting opinions from two highly respected electrophysiologists. Would you consider looking over his charts? I could mail you a comprehensive package.
We have a program set up for review of patient information. Please contact our clinical liaison nurse practitioner, Katie Dodds, at 267-426-5844.