Differences in Arrhythmia Detection Between Harvard Step Test and Maximal Exercise Testing in a Paediatric Sports...

Area of Science:

• Sports Medicine
• Cardiology
• Pediatric Cardiology

Background:

• Pre-participation screening in athletes is crucial for identifying underlying heart conditions that increase the risk of sudden cardiac death.
• Italian pre-participation screening protocols utilize resting ECG combined with either the Harvard Step Test (HST) or maximal exercise testing (MET).
• The comparative efficacy of HST and MET in detecting arrhythmias and cardiovascular conditions in young athletes is not well-established.

Purpose of the Study:

• To compare the effectiveness of the Harvard Step Test (HST) and maximal exercise testing (MET) in detecting arrhythmias in pediatric athletes.
• To investigate differences in arrhythmia detection between HST and MET, particularly in relation to sex and recovery phase.
• To assess the utility of HST versus MET in identifying arrhythmias among athletes with diagnosed cardiovascular diseases.

Main Methods:

• A cohort of 511 pediatric athletes (aged 8-18 years, 76.3% male) without pre-existing cardiovascular, renal, or endocrine diseases was studied.
• All participants underwent both HST and MET within a 30-day period.
• Data collected included absolute and relative peak heart rates, incidence of supraventricular and ventricular arrhythmias, and cardiovascular diagnoses.

Main Results:

• HST yielded a lower peak heart rate compared to MET (181.1 ± 9.8 bpm vs. 187.5 ± 8.1 bpm, p < 0.001).
• HST detected significantly more supraventricular (18.6% vs. 13.1%, p < 0.001) and ventricular arrhythmias (30.5% vs. 22.7%, p < 0.001) than MET, with a notable clustering during recovery (p = 0.014).
• In athletes with diagnosed cardiovascular diseases (22.3%), HST identified more ventricular arrhythmias (26.3% vs. 18.4%, p = 0.05), recovery-phase arrhythmias (20.2% vs. 14.0%, p = 0.035), and polymorphic arrhythmias (6.1% vs. 1.8%, p = 0.025).

Conclusions:

• The Harvard Step Test (HST) demonstrates superior efficacy in detecting both supraventricular and ventricular arrhythmias compared to maximal exercise testing (MET) in young male athletes.
• Arrhythmia detection by HST is particularly pronounced during the recovery phase, especially in males.
• HST is more effective in identifying ventricular and recovery-phase arrhythmias, including polymorphic types, in athletes with underlying cardiovascular conditions.