Utility of the exercise electrocardiogram testing in sudden cardiac death risk stratification
Marwan M Refaat1, Mostafa Hotait, Zian H Tseng
1Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon.
Insights
Exercise electrocardiogram (ECG) testing aids in sudden cardiac death (SCD) risk stratification. This method helps identify patients with or without hereditary heart conditions who are at increased or decreased risk of SCD.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Sudden cardiac death (SCD) is a significant public health concern.
- Current risk stratification methods for SCD lack sensitivity and specificity.
- Exercise electrocardiogram (ECG) testing has historical use in assessing cardiovascular function during activity.
Purpose of the Study:
- To systematically review the utility of exercise ECG testing in sudden cardiac death (SCD) risk stratification.
- To evaluate the role of exercise ECG in identifying patients who may benefit from interventions like implantable cardioverter defibrillators (ICDs).
Main Methods:
- A systematic review of the MEDLINE database was performed.
- The review focused on studies investigating exercise ECG testing for SCD risk stratification.
Main Results:
- Exercise ECG can reveal primary electrical diseases like catecholaminergic polymorphic ventricular tachycardia and concealed long QT syndrome.
- It effectively stratifies risk in conditions such as early repolarization syndrome and Brugada syndrome.
- Exercise testing can identify decreased SCD risk, exemplified by loss of preexcitation in asymptomatic Wolff-Parkinson-White syndrome.
Conclusions:
- Exercise ECG testing is a valuable tool for sudden cardiac death (SCD) risk stratification.
- This diagnostic approach is beneficial for patients with and without arrhythmogenic hereditary syndromes.
Background:
Sudden cardiac death (SCD) remains a major public health problem. Current established criteria identifying those at risk of sudden arrhythmic death, and likely to benefit from implantable cardioverter defibrillators (ICDs), are neither sensitive nor specific. Exercise electrocardiogram (ECG) testing was traditionally used for information concerning patients' symptoms, exercise capacity, cardiovascular function, myocardial ischemia detection, and hemodynamic responses during activity in patients with hypertrophic cardiomyopathy.
Methods:
We conducted a systematic review of MEDLINE on the utility of exercise ECG testing in SCD risk stratification.
Results:
Exercise testing can unmask suspected primary electrical diseases in certain patients (catecholaminergic polymorphic ventricular tachycardia or concealed long QT syndrome) and can be effectively utilized to risk stratify patients at an increased (such as early repolarization syndrome and Brugada syndrome) or decreased risk of SCD, such as the loss of preexcitation on exercise testing in asymptomatic Wolff-Parkinson-White syndrome.
Conclusions:
Exercise ECG testing helps in SCD risk stratification in patients with and without arrhythmogenic hereditary syndromes.
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