[Exercise testing in the assessment of ventricular arrhythmias (author's transl)]

During exercise, ventricular arrhythmias may be observed in 50% of healthy subjects and up to 85% of patients with heart disease. For the quantitative as well as qualitative assessment of ventricular arrhythmias, continuous ECG (Holter) monitoring is superior to the Exercise ECG. Both methods together render a 10% increase in sensitivity over that achieved through the use of one method only. In patients with repeated ventricular tachycardias, assessment through electrical stimulation is more preferable than the use of the exercise ECG or continuous ECG monitoring. In patients with coronary artery disease, ventricular arrhythmias during exercise, depending on their incidence and complexity, may indicate a two to eight-fold increase in the likelihood of cardiac death. The reproducibility of ventricular arrhythmias during repeated exercise testing is reported between 30 and 77%. Thus, in the individual patient, the complete absence of an exercise-induced arrhythmia during treatment does not permit differentiation between therapeutic effect and spontaneous variability. Accordingly, the exercise ECG is generally not an adequate method for assessment of antiarrhythmic treatment.