Effect of exercise on ventricular response to atrial fibrillation in Wolff-Parkinson-White syndrome

Ten patients with Wolff-Parkinson-White syndrome underwent cardiac electrophysiological study extended to include the induction of atrial fibrillation at maximum exercise in the upright position. This was performed using a new temporary bipolar lead with a helical active fixation tip for atrial pacing. The highest rate of atrioventricular conduction via the accessory pathway was greater during exercise than at rest in all 10 patients (mean increase 28%). In three cases the resulting ventricular rate exceeded 300 beats/min, but no patient had severe symptoms or ventricular arrhythmias. The exercise induced enhancement of accessory pathway conduction may significantly but unpredictably affect the risk from spontaneous atrial fibrillation especially in patients with coronary artery disease or in those taking antiarrhythmic drugs. The test procedure was sufficiently simple and well tolerated to be included in our routine electrophysiological investigation.