Circulation, Vol 70, 184-191, Copyright © 1984 by American Heart Association
DZ Young, S Lampert, TB Graboys and B Lown
While maximal exercise testing is useful for detection of arrhythmias and
assessment of antiarrhythmic drug efficacy, few reports have documented the
safety of this procedure in patients with malignant ventricular
arrhythmias. We reviewed the complications of symptom- limited exercise in
263 patients with such arrhythmias who underwent a total of 1377 maximal
treadmill tests. Seventy-four percent of the population studied had a
history of ventricular fibrillation or hemodynamically compromising
ventricular tachycardia and the remainder had experienced ventricular
tachycardia in the setting of either recent myocardial infarction or poor
left ventricular function. A complication was defined as the occurrence of
arrhythmia during exercise testing-- ventricular fibrillation, ventricular
tachycardia, or bradycardia--that mandated immediate medical treatment
(cardioversion, use of intravenous drugs, or closed-chest compression).
Complications were noted in 24 patients (9.1%) during 32 tests (2.3%),
whereas 239 patients (90.9%) were free of complication during 1345 tests
(97.7%). There were no deaths, myocardial infarctions, or lasting morbid
events. Clinical descriptors associated with complications included male
sex, presence of coronary artery disease, and a history of exertional
arrhythmia (p less than .05). Clinical variables previously considered to
confer increased risk during exercise, such as poor left ventricular
function, high-grade ventricular arrhythmias (Lown grade 4A or 4B) before
or during exercise, exertional hypotension, and ST depression, were not
predictive of complications (p greater than .05). Occurrence of a
complication was also unaffected by the use of antiarrhythmic drugs at the
time of exercise (chi square = 0.19, p greater than .05).(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Safety of maximal exercise testing in patients at high risk for ventricular arrhythmia
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