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Exercise testing in the presence of complete heart block
Christopher C Dunbar1, Barry I Saul, John T Kassotis
1Department of Physical Education and Exercise Science, Brooklyn College, City University of New York, and Division of Cardiology, The New York Methodist Hospital, Brooklyn, NY 11210, USA. ccdunbar@brooklyn.cuny.edu
Medicine and Science in Sports and Exercise
|September 7, 2007
Summary
Exercise ECG stress testing can be beneficial for patients with complete heart block, even when it
Area of Science:
- Cardiology
- Electrophysiology
- Diagnostic Testing
Background:
- High-grade atrioventricular (AV) block is a relative contraindication for exercise testing.
- Preoperative evaluation of a 28-year-old female revealed complete heart block with a junctional escape rhythm.
Observation:
- The patient underwent a symptom-limited maximal ECG treadmill test using the Bruce protocol.
- Resting heart rate was 47 bpm, blood pressure 70/50 mm Hg.
- During the test, sinus rhythm with first-degree AV block was observed, with peak heart rate 122 bpm and peak blood pressure 122/70 mm Hg.
Findings:
- The patient achieved 10.2 METs and remained asymptomatic throughout the test.
- No significant arrhythmias or ischemic changes were noted.
- The test was terminated due to inability to maintain treadmill pace.
Implications:
- Exercise ECG stress testing can provide valuable information in select patients with complete heart block.
- The benefits of diagnostic exercise testing may outweigh the risks in specific clinical scenarios.
- This case supports the judicious use of exercise testing for guiding management decisions, such as pacemaker implantation.
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