Safety and Efficacy of Scientist Led Exercise Stress Testing for Arrhythmia Provocation and Chronotropic Competence

For many years, non physician led exercise stress testing performed for the investigation of coronary artery disease has been endorsed by many cardiovascular (CV) societies and associations around the world. The safety guidelines don't currently include the performing of these tests for arrhythmia provocation or chronotropic assessment. Therefore, the aim of this study was to assess the safety and efficacy of non physician led EST performed for suspected arrhythmias, chronotropic competence, long QT, and accessory pathway conduction (APC) assessment. A total of 486 patients performed an exercise stress test for either of the above suspected conditions and were followed for 1.8 years ± 1.5 years. Tests were performed by a trained cardiac scientist with all reports over-read by a consultant Cardiologist. There were no significant adverse events (myocardial infarction, arrhythmia causing hemodynamic compromise or syncope) at time of testing. A total of 12.1% of patients required further follow up consisting of either a cardiac pacemaker, an implantable cardioverter defibrillator, radiofrequency ablation, Direct-Current cardioversion or a change in medications. Interobserver agreement between the Cardiologist and cardiac scientist was 98.4% indicating excellent agreement. In conclusion, the present study demonstrates that cardiac scientists can safely perform non physician led EST for the investigation of suspected arrhythmias, chronotropic competence, long QT, and APC assessment with a diagnostic interpretation equivalent to that of a consultant Cardiologist.