Exercise Testing in the Management of Arrhythmias
Atrial and ventricular arrhythmias are commonly seen with exercise stress testing (EST); these are almost always nonsustained, and the significance of those findings is, at best, modest. For patients with structurally normal hearts and combinations of isolated and repetitive ventricular ectopy, EST offers some mechanistic data and some marginal long-term prognostic data. Patients with increased ectopy during exercise or immediately post exercise deserve enhanced follow-up.
In patients with congenital heart disease, EST data, in conjunction with data regarding an individual’s hemodynamic and disease-specific risks, is sometimes helpful in assessing the patient’s overall risk profile. Comprehensive assessment of patients with atrioventricular block (AVB) and pacemakers using EST, including expired gas analysis when feasible, can help define their functional capacity and inform decision-making about programming, lead revisions, or deferring therapy. Exercise testing can also help refine both implantable cardiac defibrillator (ICD) programming and medical therapy to limit inappropriate and appropriate therapies.
Catecholaminergic polymorphic ventricular tachycardia is a specific genetic and clinical disorder that is defined by the exercise arrhythmia response. Repeated EST is one part of sequential assessment of therapy.
For arrhythmogenic cardiomyopathies, while exercise testing is part of their overall clinical and phenotypic characterization, the response to EST will generally be only part of the overall decision-making.
KeywordsExercise stress testing Arrhythmias Catecholaminergic polymorphic ventricular tachycardia Arrhythmogenic cardiomyopathies Bradycardia Sinus node dysfunction Atrioventricular block Implantable cardiac defibrillator Tachycardia Supraventricular tachycardia Ventricular arrhythmias Arrhythmogenic cardiomyopathy T-wave alternans
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