Introduction Premature Ventricular Contraction (PVC) is a pattern seen on daily basis in ECGs which always puts physicians in a dilemma what and when to intervene. PVCs tend to occur in minority of the athletes, we should plan for 24 Hours Holter monitoring to further quantify the burden and to understand the morphology if there are more than 2 PVCs on a standard 10 second ECG.

Case Presentation A 32 year old healthy asymptomatic soldier was referred to us for cardiac assessment prior to overseas mission. He is a fit built gentleman with unremarkable physical examination with a resting ECG showing ectopic atrial rhythm, frequent PVCs in bigeminy pattern; likely Anterior (Free wall) RVOT PVCs. Exercise Stress Test negative at high workload, PVC disappear at low workload with no recurrence at high workload suggestive of benign RVOT PVC. Echocardiogram reveals features of Athletes’ Heart (ASE 2014), no evidence of cardiomyopathy, good LV systolic function and normal diastolic function. Incidental findings of Congenital Quadricuspid Aortic Valve (QAV) Type B (Hurtwitz and Robert’s classification with Trivial AR. 24 hours Holter came back with a PVC burden >15% with episodes of Non-Sustained VT.

Case Discussion The morphology of PVC carries an important diagnostic and prognostic value. In athletes, the presence of premature ventricular contractions (PVCs) can be a benign finding or indicative of underlying cardiac pathology. Root PVCs, originating from the root of the heart's ventricles, may present more frequently in individuals with high athletic training due to increased vagal tone and heightened cardiac output. While often asymptomatic and benign in this context, persistent or symptomatic PVCs necessitate careful evaluation to rule out potential structural heart disease. Based on his Holter results given that he is asymptomatic throughout but him being an active military personal the need for ablation is still considerable.

Conclusion It is important to differentiate morphologies of PVC for accurate diagnosis and further evaluate PVC burden to rule out catastrophic cardiac conditions.