Exercise and Exercise Stress Testing in Brugada Syndrome: Diagnostic, Prognostic, and Safety Implications
Pattara Rattanawong1, Narathorn Kulthamrongsri2, Eugene H Chung3
1Pali Momi Medical Center, Hawai'i Pacific Health, Aiea, Hawaii, USA; Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA.
JACC. Asia
|June 3, 2026
Summary
Exercise stress testing (EST) can reveal Brugada syndrome by unmasking arrhythmias during recovery. This diagnostic tool, when optimized, aids in risk stratification for sudden cardiac death.
Area of Science:
- Cardiology
- Electrophysiology
- Genetics
Background:
- Brugada syndrome is a genetic cardiac channelopathy linked to sudden cardiac death from ventricular arrhythmias.
- Pharmacologic sodium channel blocker testing is standard, but exercise stress testing (EST) is gaining diagnostic importance.
Purpose of the Study:
- To evaluate the role and safety of exercise stress testing (EST) in diagnosing Brugada syndrome.
- To identify specific phases and markers during EST that unmask arrhythmic risk.
Main Methods:
- Review of evidence on exercise stress testing (EST) in Brugada syndrome patients.
- Analysis of arrhythmias provoked during peak exercise and early recovery phases.
- Consideration of adjunctive measures like high precordial leads and drug provocation.
Main Results:
- Peak exercise may reveal depolarization abnormalities, while early recovery unmasks repolarization abnormalities and the type-1 Brugada pattern.
- Exercise-induced premature ventricular contractions and ST changes during recovery are significant arrhythmic risk markers.
- EST is generally safe with monitoring and can improve diagnostic accuracy.
Conclusions:
- Optimizing EST protocols, especially focusing on the recovery phase, can enhance Brugada syndrome diagnosis.
- Integrating recovery-phase markers into EST may improve individualized risk stratification for sudden cardiac death.
Related Concept Videos
01:26Exercise Stress Test
Introduction
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:30Acute Coronary Syndrome III: Diagnostic Studies
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
01:29Electrocardiogram
An electrocardiogram (ECG or EKG) is a critical diagnostic tool that records the electrical signals produced by the heart during each heartbeat. This recording is achieved through electrodes placed strategically on the arms, legs, and chest. The electrocardiograph amplifies these signals and produces 12 distinct tracings, offering a comprehensive understanding of the heart's electrical activity.
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and the T...
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and the T...
01:30Dysrhythmias V: Evaluating Dysrhythmias
Dysrhythmias, also known as arrhythmias, are disturbances in the heart's rhythm that range from benign to life-threatening. A thorough evaluation is crucial for appropriate management and involves a comprehensive medical history, physical examination, and various diagnostic tests.Medical HistorySymptoms: Collect detailed information on palpitations, dizziness, syncope, chest pain, and fatigue. Note their onset, frequency, and triggers.Previous Cardiac Issues: Document any history of heart...
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
01:20Exercise and Cardiovascular Response
Exercise significantly impacts cardiovascular response, which is crucial for understanding patient health and designing effective treatment plans.
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...