Ventricular arrhythmias (VA) are the most significant marker of sudden cardiac death and a sign of cardiovascular diseases with an unfavorable prognosis of outcome. This is especially true for ventricular ectopy induced by physical exercise (PE), though such arrhythmias are poorly studied.
OBJECTIVE
To study clinical and electrocardiographic features and determine clinical significance of VA triggered by PE.
MATERIAL AND METHODS
The study included 80 patients with daytime type of VA according to 24-hour Holter ECG monitoring (HM), reproducible and progressive during treadmill test (TT).
RESULTS
According to the examination results the patients were divided into the following groups: group I — 15 patients (age 45 to 70 years, average age 58.1 years) with VA associated with transient myocardial ischemia; group II — 65 patients with VA not associated with transient myocardial ischemia, including group IIA — 25 patients with arterial hypertension (age 26 to 72 years, average age 53.6 years), group IIB — 21 patients with minor cardiac abnormalities (age 25 to 65 years, average age 34.4 years), group IIC — 19 patients with idiopathic VA (age 28 to 52 years, average age 34.4 years). Most patients in groups I and IIA showed a new type of ectopy during TT. In groups I and IIB, all patients had gradual progression of VA, whereas in groups IIA and IIC episodes of sudden sustained ventricular tachycardia without preceding single and paired ventricular ectopic complexes were observed. An inverse relationship between the average age of the patients and PE tolerance and a direct relationship between chronotropic reserve and the of sinus rhythm rate at the onset of the arrhythmia were demonstrated. At the prospective follow-up, 4 patients from group IIC were diagnosed with arrhythmogenic right ventricular cardiomyopathy/dysplasia, and 8 patients from group IIA and 7 patients on follow-up care were diagnosed with coronary heart disease.
CONCLUSION
Stress-testing is a more conclusive diagnostic method for PE-induced arrhythmias than HM. Clinical and electrocardiographic analysis during TT, careful examination, and prospective follow-up in cases of undiagnosed heart disease should be recommended in patients with PE-induced VA.
