Reproducibility of exercise-induced ventricular arrhythmia in patients undergoing evaluation for malignant ventricular arrhythmia

Saini, Vikas; Graboys, Thomas B.; Towne, Virginia W.; Lown, Bernard

doi:10.1016/0002-9149(89)90254-3

Cited by 20 publications

(4 citation statements)

References 16 publications

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“…Second, exercise stress test may not be fully reproducible. Previous studies have demonstrated a reproducibility of 55–76% of exercise‐induced ventricular arrhythmias in maximal exercise stress test 22,23 . In fact, a few studies have reported false negative exercise stress test results among symptomatic, genetically confirmed CPVT patients 14,15,24 .…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have demonstrated a reproducibility of 55-76% of exercise-induced ventricular arrhythmias in maximal exercise stress test. 22,23 In fact, a few studies have reported false negative exercise stress test results among symptomatic, genetically confirmed CPVT patients. 14,15,24 Due to these pitfalls, judging the epinephrine administration test on the basis of the results on maximal exercise stress test may not be accurate.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Intravenous Epinephrine Infusion Test in Diagnosis of Catecholaminergic Polymorphic Ventricular Tachycardia

Marjamaa

Hiippala

Arrhenius

et al. 2011

Cardiovasc electrophysiol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intravenous Epinephrine Infusion Test in Diagnosis of Catecholaminergic Polymorphic Ventricular Tachycardia

Marjamaa

Hiippala

Arrhenius

et al. 2011

Cardiovasc electrophysiol

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“…22 The efficacy and dose adjustment of the antiarrhythmic therapy is confirmed by exercise stress testing. [29][30][31] In the patient reported here, the possibility of structural heart disease was ruled out by appropriate testing, including transthoracic echocardiography, cardiac magnetic resonance imaging, cardiac catheterization, coronary angiography, and endomyocardial biopsy. The electrocardiogram was within normal limits.…”

Section: Discussionmentioning

confidence: 99%

Exercise-Induced Bidirectional Ventricular Tachycardia with Alternating Right and Left Bundle Branch Block-Type Patterns

Khan¹

2002

Angiology

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Exercise-induced ventricular tachycardia in young adults may occur with various structural heart diseases or with structurally normal heart. The structural heart diseases reported to cause exercise-induced ventricular tachycardia in this patient population include arrhythmogenic right ventricular dysplasia, hypertrophic cardiomyopathy, dilated cardiomyopathy, myocarditis, congenital heart disease, and myocardial ischemia. The conditions well identified to cause exercise-induced ventricular tachycardia with structurally normal heart are congenital long-QT syndrome and familial polymorphic ventricular tachycardia. Exercise-induced ventricular tachycardia may display polymorphic, monomorphic, or bidirectional morphologies. A case of exercise-induced catecholamine-sensitive bidirectional ventricular tachycardia with alternating right and left bundle branch block patterns is reported in a young boy in the absence of structural heart disease, the conditions causing bidirectional ventricular tachycardia, and family history of such an event or sudden cardiac death. The bidirectional tachycardia typically displays right bundle branch block in right precordial leads with alternating polarity of the QRS-complex in frontal plane leads but in this case the bidirectional morphology of tachycardia was caused by alternating right and left bundle branch block-type patterns. The conditions causing bidirectional ventricular tachycardia are digoxin toxicity, ischemic heart disease, hypokalemia, myocarditis, and familial polymorphic ventricular tachycardia syndrome but the exact cause in this patient remained obscure, and the possibility of an underlying electrical or ion channel disease of the heart could not be ruled out.

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“…119,120 It must be concluded that the marked variability of ETIVA during repeat maximal exercise testing in a clinically normal population appears to negate the usefulness of this finding during a single test as a marker of future cardiovascular disease. 119,120 It must be concluded that the marked variability of ETIVA during repeat maximal exercise testing in a clinically normal population appears to negate the usefulness of this finding during a single test as a marker of future cardiovascular disease.…”

Section: Manual Of Exercise Testingmentioning

confidence: 99%

Interpretation of the Electrocardiogram

Froelicher

2007

Manual of Exercise Testing

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MANUAL OF EXERCISE TESTING1975-Simoons and Hugenholtz 5 reported Frank lead vectorcardiographic changes during exercise in normal subjects. The direction and magnitudes of time-normalized P, QRS, and ST vectors and other QRS parameters were analyzed during and after exercise in 56 apparently healthy men, ages 23 to 62 years. The PR interval and the P-wave amplitude increased during exercise. Direction of the P vectors did not change, differing with previous reports that had noted changes consistent with right atrial overload. No significant change in QRS magnitude was observed, and the magnitude in spatial orientation and the maximum QRS vectors remained constant. QRS onset to T-wave peak shortened. The terminal QRS vectors and the initial ST vectors gradually shortened and shifted to the right and upward. The T-wave amplitude lessened during exercise. In the first minute of recovery, the P and T magnitudes markedly increased, and then all measurements gradually returned to the resting level. There was an increase in S-wave duration in leads X and Y, and right-axis shift in the QRS complex was heart rate dependent. The ST-segment shifted upward to the right and posterior, and T-wave magnitude increased markedly in the first minute of recovery. The QRS complex shortened in some young individuals during exercise. 1979-The United States Air Force Medical Corps (USAFMC) NormalAircrewmen Study was based on digital data from 40 low-risk normal subjects, processed, and analyzed across treadmill times on the basis of waveform component and lead. 6 USAFMC Normal Aircrewmen StudyFigure 4-1 illustrates the waveforms produced using median values of the measurements of all 40 subjects for leads V5, aVF (Y), and V2 (Z). These figures demonstrate the specific waveform alterations that occur in response to maximal treadmill exercise. Supine, exercise to a heart rate of 120 beats per minute, maximal exercise, 1-minute recovery, and 5-minute recovery were chosen as representative times. There is depression of the J junction and peaking of the T waves at maximal exercise and at 1-minute recovery. Along with the J-junction depression (QRS end or ST0), marked ST upsloping is seen. J-junction depression did not occur in the Z lead (which is equivalent to and of the same polarity as V2). As the R wave decreases in amplitude, the S wave increases in depth. The QS duration shortens minimally, but the RT duration decreases in a larger amount. Q-Wave, R-Wave, and S-Wave AmplitudesIn leads CM5, V5, CC5, and Y, the Q wave shows very small changes from the resting values; however, it does become slightly more negative at maximal exercise. Q-wave changes were not noted in the Z lead. Changes in Key Point: Junctional ST depression below the PR isoelectric line is normally seen with increasing heart rate, and early repolarization normally decreases to or below the isoelectric line.median R-wave amplitude are not detected until near-maximal and maximal effort is approached. At maximal exercise and on into 1-minute recovery, a sharp decrease in R-...

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Reproducibility of exercise-induced ventricular arrhythmia in patients undergoing evaluation for malignant ventricular arrhythmia

Cited by 20 publications

References 16 publications

Intravenous Epinephrine Infusion Test in Diagnosis of Catecholaminergic Polymorphic Ventricular Tachycardia

Intravenous Epinephrine Infusion Test in Diagnosis of Catecholaminergic Polymorphic Ventricular Tachycardia

Exercise-Induced Bidirectional Ventricular Tachycardia with Alternating Right and Left Bundle Branch Block-Type Patterns

Interpretation of the Electrocardiogram

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